Wash authors april ryan and cal thomas sunday on book tv on cspan2. Health alec cesar health and Human Services secretary azar was in washington. He talked about the federal government response to the outbreak and testifying on the president s 2021 budget request. The second panel on the Coronavirus Response, those questions will be limited to five minutes, which is the usual case. Only 10 members will be able to ask questions during that round. I will have to be strict with the gavel. Since the witnesses have a tight timeframe and i know that you will all cooperate with that. Let us begin. Welcome, mr. Secretary. We are glad that you are here. We have a lot to take up and every bit of it is obviously series. The chair recognizes yourself for five and its for an opening statement. Let me begin with this. , mr. Secretary i think that confusion is the enemy of preparedness. Confusion is the enemy of preparedness. I believe that the administrations lack of coordination for the Coronavirus Response is on full display. Markets are reacting. I think in some part to the lack of trust information amongst many other factors. Our government across the government has to speak with credibility and authority. Greatd, it is like a chorus chanting on the side of the stage. ,e have one thing being said the president saying Something Else. That adds to the confusion. I think that there are key questions that need to be addressed for the American People. What is the plan, the overall plan should this virusinfected americans in fact virus infect americans in high numbers . Tests, we all know, have a limited reliability to diagnose the virus. The small number, it could be said, of u. S. Cases it may reflect limited testing and not how the virus is spread. It is up to our professionals to put out with clarity that kind of information. What is the plan for protecting our Health Care Workers that are in the frontlines of this . What is the plan to increase Hospital Capacity . View, the United States of america has the premier professional Public Health professionals in the world, in the world. Thoseientists, doctors, are heading up the agencies, those that are part of the agencies. I think the problem rests more with administration people. One saying one thing, others saying Something Else. I think that the briefings that are done for the congress, if i might suggest, should be open to the public. There is no reason to have secrets about this. I say that because it raises the element of fear with people. There is something going on behind closed doors that they are not telling us. It is a time for us, if i might use the expression, to give them an inoculation of confidence. Certainly, the virus triggers fear. I think the antidote for this is truth and transparency, including informing the american coordinated, fully funded government plan to keep us safe. These are not things they can do for themselves. We are the ones. You are certainly in the drivers seat on this. I think that the funding requests and later in my questions, i will ask you about that, is wholly inadequate. Before requesting emergency funding, the president s budget contained dangerous cuts that weakened our Public Health frontline response, got the Health Care Safety net, and end programs focusing on increasing our health care workforce. So we are driving in the wrong direction. A fire and there is the fire engine is going down the wrong end of the road instead of to the fire. We need these resources in order to care for the American People. As the author of the pandemic and all hazards preparedness act, i know that the best way to fight outbreaks is by preparing and investing in advance, not by rushing after a pandemic its. Hits. While the virus is spreading, the president s budget cuts almost 700 million from the cdc, 400 30 million from the National Institute focused on Infectious Diseases. 3 billion from the governments Global Health program. This is a job dropping 1. 6 dropping 1. 6jaw trillion dollars cut from the federal programs that cover one in three americans. This does not make any sense. The president s budget virtually ends the Workforce Development programs that train more than half a million clinicians each year. I see them each week in my Congressional District at Stanford Medical Center and Lucille Packard childrens hospital. The budget weakens our Public Health safety net hurts our countrys resiliency. Nih, all these agencies cannot run on fumes, cannot run on fumes. If itnot even a tesla does not have a battery that is going to last. If americans are uninsured or underinsured, they are not going to seek care. That will contribute to the spread of the disease. , as the president has often promised, Beautiful Health care. I dont find beauty in what i just said. Im sorry that this is a part of it. With that, i will have questions. Thank you again for being here. The chair now recognizes the doctor, the Ranking Member of our subcommittee, for his five minutes for an opening statement. Thank you, secretary, for being here. Always great to see you in our committee. I hope the feeling is mutual. I just have to say, madam chair, that two weeks ago, i was criticized rather severely for even suggesting that we needed a coronavirus hearing. The work that we were doing that day was so important that we did not need to do that hearing. We did need to do that hearing. I am grateful we are having it today. I am grateful we have the secretary. This hearing is also being coincidently run with the president s Budget Proposal for fiscal year 21. That is a lot of stuff to cover in one hearing. I guess we will do our best, mr. Secretary. I do appreciate the administrations commitment to health care. I appreciate the commitment to lowering Health Care Costs and reducing the complexity of the system so that patients can more easily access their care. One thing the administration and mr. Secretary, particularly you, led on was advancing kidney help for Americans Health for americans. That trend continues. This bill would extend Medicare Coverage of immunosuppressive drugs past the current 36 month limit. A patient with a kidney transplant needs to take immunosuppressives are there body will ultimately reject the graft. A kidney transplant is indeed an investment in the future of that patient and this bill will help protect that investment. I am thankful it has been highlighted as a priority by the administration. It is time for congress to finally pass this common sense legislation. The opiate epidemic and programs investigativeht committee making sure the programs are indeed a priority. In our oversight investigation subcommittee, we have heard from various states of the efforts they are making to help those with Substance Use disorder. Funding for these grants is imperative to allow states to find the innovative ways to combat this crisis. Fact that thehe administration include the hyde amendment. Important to ensure that federal funds are not used to perform abortions. The Appropriations Committee puts together the bills for fiscal year 2021 and they will maintain those protections. Other important programs and policies receiving increased funding, including the maternal grant d block the coronavirus has infected over 80,000 individuals worldwide, proven to be more deadly than sars. I appreciate the Trump Administrations vigilance and Rapid Response efforts. I was so heartened when you came on the air and said there was a limit to people being able to come into this country from china. I thought that was important that the administration say that. I believe that is one of the central things. My thesis is that is one of the central things that has provided us at least a little breathing room as this virus erupts around the world. We are fortunately not as effective as some other countries. Now it is incumbent upon us to make sure we utilize that time wisely. Certainly, the pandemic and all hazards preparedness act, which was worked on by this subcommittee, important piece of legislation. I would have liked for us to have done realtime hearings updating, are we doing what was intended with that bill . Is the stockpile responding appropriately to the authorizations that we made . This is the type of information, rather than the political rhetoric backandforth that we have heard, this is the type of information i think would be helpful and indeed reassuring to the American People. You cant ignore the fact of what has happened to the markets. Today, they seem to have rebounded a little bit. We all know china has not been forthcoming with information. It is that uncertainty, that uncertainty that i believe is driving one of the negative forces one of the negative forces driving the market. We will have multiple questions for you. I certainly look forward to your testimony. I yields back. The gentleman yields back. I want the Ranking Member to know the following. On january 30, i requested that the following week that we have a hearing on the coronavirus with the heads of the agencies. Saidecretary leaned in and i had up the effort and i want to be there with that team. Here we are today. Something that we just casually overlooked or ignored. I now would like to recognize the chairman of the full committee for his five minutes. Todays hearing serves two critical purposes. First, we will examine the trumpet demonstrations proposed budget for the apartment of health and Human Services for fiscal year 2021. Second, we will get a crucial update to the administrations ongoing response to the coronavirus. I am disappointed yet not surprised that the Budget Proposal completely contradicts the health care promises that the president repeatedly makes to the American People. Comes to ensuring the American People have access to affordable and Quality Health care, the Trump Administration has failed them and this Budget Proposal continues that record. After showering the major corporations with major tax breaks, the 2021 budget slashes from the Affordable Care act and medicaid. The president wants to make it easier for states to take away peoples coverage, undermined undermine their care, and cut critical benefits. This puts the health and wellbeing of tens of millions of children, parents, pregnant women and people with disabilities at risk. It is unconscionable that the president wants to cut medicaid to pay for tax cuts for millionaires. These budget cuts also fly in the face of President Trumps own words. He promised he would not cut medicare or medicaid. He promised in the state of the Union Address earlier this year that he would continue to protect them more than 130 million americans with preexisting conditions. As the secretary knows, this administration is now suing in the federal courts to strike down the aca and all of its consumer protections. Overall, President Trump is proposing a 12 cut to the hhss budget, one of the largest cuts to any federal agency. The president s proposal cuts the National Institutes of health by 3 billion and the centers for Disease Control and prevention by 675 billion. This is the very agency debt is now responding to the coronavirus. I am also concerned by the proposal to move tobacco regulation out of the fdas authority altogether. Instead, the administration would create new agency to oversee Tobacco Products while we are in the midst of a Youth Tobacco epidemic. The act clearly and fdabiguously ensured that would regulate Tobacco Products with the protection of Public Health. Over the last decade, the agency has worked to develop the expertise, workforce and scientific base to regulate these products. I am concerned that this proposal would only serve to further politicize tobacco regulation by stripping away the sound, scientific and evidencebased approach and replacing it at the whims of political appointees. To if nothing more, a gift big tobacco companies. Let me move to the let me move to the second topic at hand. We will ask questions of the secretary and other Top Health Officials on the administrations efforts to address the coronavirus outbreak. It is critical we get an update on the scale of outbreak, repercussions and how we can Work Together to ensure the safety of all americans. I i think we have one of the strongest infrastructures in the world. More than capable of coming to an effective solution. We should be supporting that with all available resources. Again, adam chair, i thank you. Well, actually, i have time left, if anybody wants it. Everybody gets time . Anybody want my time . All right. Thanks i yield back. Gentleman yields back. Pleasure to recognize mr. Walden for his opening statement. Mr. Secretary, thank you for being here today. Not the first time we have seen you. Here this year, probably. We certainly appreciate the work you and your team have done dealing with the coronavirus. I think ive been in every one of the roundtable and hearings that you and your team have provided for this committee and other committees. The comoderators of the first one in the Visitor Center where every member of congress was invited. I was at the last one and i was at the situation room at the white house before the break. You know, i think you all have been very forthcoming with the facts. For whatever reason, we have not had a hearing here, maybe wanting to wait until this one, but i think it is important that we hear from you and the team that you are leading. I think it is important to recognize the work that misses brooks did on reauthorizing the pandemic all hazards preparedness act in the last congress. We had big fights about that. Thank goodness it is in place because it is designed to do exactly what we are encountering today. Have a lead person in the administration that is you, designated by the president and a team ready to go. I guess i have been to enough of those briefings that i so members kind of yawning and i saw members yawning in those closed door briefings. We are hearing it for the third time. We are gone a week and a lot has changed. We know what is happening in china is probably worse than we are being told. I think the big issues there are supplychain, as well as Public Health. We know that it is spreading around the world. We know, and you have warned us, other doctors have warned us, expected this could well mutate. It can well expand. We should be ready for that. We have a terrific Public Health system here in the United States. A lot of that is driven at the local level. It is important we have those communication links in place so when we identify something, someone coming into an airport, Health Officials know about it at home and we are able to deal with it. Asper ands an update on the sidecar hearing we have 80,000 confirmed cases worldwide. 2700 deaths. The outbreak has become a Significant Health concern. Yesterday italy announced 300 individuals affected by the coronavirus. Eleven have died. There is still so much we do not know about the outbreak. We will learn more after this Budget Hearing. It is, essential, that we do everything that we can and provide you the assistance. I know the meeting that i have been in, you have made it clear, if you need more money, you will ask it. We have made it clear, if you need more money, tell us and we will work with you. I know you have sent up a supplemental request for, i think a total of a little over 2 billion. Some of that is reprogramming. Some of that is additional money no sooner left your office and some politicians on the air criticizing you for not asking for enough. We will be interested to get your response to that. I do think it is also essential to look at perspective, in terms of what americans are facing today with the traditional flu. And that we probably lost, what, 10,000 or more americans have died from the annual flu, and we have vaccines for that, treatments for that. We have to think about that as well. And practice good Public Health. I was in japan with a couple of my other colleagues on the committee and you cannot go anywhere in japan without the Hand Sanitizer being squirted in your hand. It was a good lesson, i think, for all of us. We ought to be doing more of that here. It would probably help with the traditional seasonal flu. Theres a lot we can learn from you. A lot we can learn from your team. We look forward to hearing from you directly on that. With that, madam chair, i yield back. Gentleman yields back. I now would like to introduce our witness for todays first panel. One person, one person alone did alone, the nations secretary of health and Human Services. Welcome to you, secretary azar. You certainly are aware with the lighting system around here. You are now recognized for five minutes for your statement to the committee. Thank you very much. Thank you for inviting me to discuss the president s budget for fiscal year 2021. Im honored to appear before the committee for budget testimony as the hhs secretary for the second time, especially after the remarkable result that the hhs team has produced. This past year we saw the number of Drug Overdose deaths decline for the first time in decades. Another record year of generic drug approval from fda, historic drops a Medicare Advantage, Medicare Part b and Affordable Care act exchange agreements. The president s budget aims to move towards a future where hhs programs work better for the people we serve. Human Service Programs put people at the center and where americas Healthcare System is affordable, personalized, puts patients and control treats them like a human being and not like a number. Hhs has the largest discretionary budget of any nondefense department. Difficult decisions must be made with Discretionary Spending on a sustainable path. The president s budget proposes to protect what works in our Healthcare System and make it better. I mention two ways that we do that. First facilitating patient centered markets and second tackling key impeccable health challenges. The budget healthcare reform aim to put the patient at the center colonoscopy a lifesaving services. Paying the same for certain services, regardless of setting. The budget endorsesset. The budget endorses bipartisan, bicameral drug pricing legislation. I want to thank this committee for your bipartisan work to pass legislation to cut patient cost and save taxpayer dollars through lower drug prices. The budgets reforms will improve medicare and extend the life of the Hospital Insurance fund for at least 25 years. We propose investing 116 million in hhs initiatives to reduce Maternal Mortality and morbidity, and we propose tackling americas Rural Health Care crisis telehealth expansion and new flexibility for rural hospitals. The budget increases investments to combat the Opioid Epidemic including sams clubs state samsas state opioid response program. This Successful Grant Program grew out of this committees creation of the state targeted response grant. We were pleased to work with congress to provide flexibility on the s. O. R. Grants for states to address stimulants like methamphetamines. We request 716 million for the president s initiative to end the hiv epidemic in america by using effective evidencebased tools. Thanks to support from congress, we have already begun implementation of the initiative. The budget reflects how seriously we take the threat of other Infectious Diseases such as the Novel Coronavirus. By prioritizing the funding for cdcs Infectious Disease programs and maintaining investments in hospital preparedness. As of this morning, we still had only 14 cases of the Novel Coronavirus detected in the United States involving travel to or close contacts with travelers. Coming into this hearing, i was informed that we have a 15th confirmed case, the epidemiology of which we are still discerning. Three cases already exist among americans repatriated from wuhan and 42 cases exist among american passengers repatriated from the diamond cruise ship in japan. While the a meeting risk to the American Public remains low, there is now Community Transmission in a number of countries including outside of asia which is deeply concerning. We are working closely with state, local and private sector partners to prepare for mitigating the virus potential spread in the United States as we expect to see more cases here. On monday, a request to make at least 2. 5 billion in funding available for preparedness and response including for therapeutics, vaccines, personal protective equipment, state and local Health Department support and surveillance. I look forward to working closely with congress on that proposal. This years budget aims to protect and enhance americans wellbeing and deliver americans a more affordable, personalized Healthcare Systems that work s better rather than just spend s more. I look forward to working with this committee to make that commonsensical a reality. Common sense goal a reality. Thank you very much. Thank you, mr. Secretary. We will now move to member questions. I will recognize myself for four minutes, which will be the limit for questions to the secretary. Mr. Secretary, we know that on february 24, the acting director of omb was requested the appropriation of 100 1. 25 billion for emergency funding for the virus. Is that what you requested of omb . Sec. Azar so the actual total , supplemental authorization would be 2. 5 billion. Fundingw, but the new is 1. 25 billion. Sec. Azar i want to emphasize as i told the appropriators, that was meant as a suggestion, a way to fund half of it, if congress decides there are other approaches, we are not wed to that. What exactly does that cover . Is it anticipatory . Yesterday the cdc said essentially we need to be prepared for a much larger spread of this virus in the United States. Requested aneen emergency funding to cover a broader plan or is it on the figures that you just gave us . Sec. Azar so it is to cover expenses that we believe are appropriate for 2020. This would go through the end of 2020 fiscal year. And then we would work with the appropriators on any adjustments to 2021 appropriations in the weeks ahead we are continuing to learn about the disease. Expanding our surveillance system. Rep. Eshoo i have some other questions. Sec. Azar sure. Im happy to walk you through. Rep. Eshoo i read the entirety of your printed statement. I want to turn to the status of drug pricing policy proposals. You can just say yes or no. It would be great. Have you finalized a policy ending drug rebates to middlemen in medicare . Rep. Eshoo we did not move forward with that role. Rep. Eshoo ok. Have you finalized a policy tying drug prices to the lowered cost reference pricing . Sec. Azar we had an advance notice of proposed rulemaking. That was not an actual formal proposal. Rep. Eshoo have you finalized a proposal to make drug manufacturers to put prices in Television Advertisement . Sec. Azar we did. Much to our shame, the Pharma Industry Student Congress has sued and congress has not passed explicit operation for that list price requirement in the statute. We plan to finalize as soon as we can implementing section a. To allow lowcost importation from canada. Rep. Eshoo you know that the house passed hr3. You also know that the president said that we are going to negotiate, negotiate, negotiate so hard, Something Like that. We will negotiate like crazy. Do you support direct negotiations . Sec. Azar we do not support hr3 because we dont believe the negotiation framework is either a negotiation framework or actually practical and implementable. It also has no chance of passing in the senate. It is struggling even to get to the floor there. Rep. Eshoo well, hr3 caps outofpocket as you know, prescription costs for seniors. Do you support the capping of outofpocket costs . Sec. Azar we have an important opportunity here, bipartisan rep. Eshoo yes or no. Sec. Azar reduce what seniors yes, we do. Rep. Eshoo well, i think ive asked let me just, well, hr 3 also limits drug price hikes to inflation. Do you support the inflation caps . Sec. Azar so that is part of the Grassley Wyden package. We have made clear it is a package we can support. It is not the only bipartisan package, but the Price Inflation penalties in part d and b are acceptable to us as the means of getting list prices under control. Sec. Azar rep. Eshoo thank you. My time has expired. I now would like to recognize the Ranking Member of the subcommittee for his four minutes of questions. Thank you. Secretary, in december 2018, the president signed two important bills into law that addressed Maternal Health and Maternal Mortality. The first bill representative Jamie Herrera butlers preventing Maternal Death acts. States to establish or expand. Maternal mortality review committees. The other bill, improving access to Maternity Care act, requiring resources 20 to five professional target areas. So how have you used these bills . How is your Agency Building on the success of those two laws to assure access to quality Maternity Care and protect Maternal Mortality . Sec. Azar first, could i thank you for your leadership on amino suppressive drugs . We put in the budget what you have long advocated for. Rep. Burgess yes, you may say thank you. Sec. Azar on the work of Maternal Mortality the work of , Congress Focusing on this critical issue. Committee women are dying in childbirth, prechildbirth, postpartum. A serious part of the agenda with 116 million initiative, with a 74 million increase. It focused on improving prevention, quality improvement, Postpartum Health and improving the Data Collection on that. So a fourpart strategy that we look forward to working with congress with coming out of the budget. Rep. Burgess thank you for that. Republicans of this subcommittee in 2017 sent to your predecessor, secretary price and , a letter to update on releasing the influence of plan. Previously had not been updated since 2005. Can you describe how you are using the pandemic influenza plan as a guide in preparing for your response to this current outbreak of the coronavirus . Sec. Azar so as you know i was , one of the architects of the original plans back in the bush administration. That work is foundational. That is what has set up our entire state, local Preparedness Program for any type of viral outbreak for this. And so it is really the face it is the blueprint for how we are operating today, including my role leading through the Emergency Support function 8 under the National Response plan which is the doctrine that we have in place for 15 years. Rep. Burgess let me just say, this committee did do work on hr3 last october. There was concern for many of us that the negative effects on innovation and development would really be profound. And now we find ourselves confronted with this coronavirus outbreak, where we know we need new antivirals. We know we need new vaccines. We know we need more mana cockle coccle antibodies to help people who become ill. Can you just speak to the fact of, is innovation still important . We heard several times in the subcommittee and full committee, maybe innovation was not so important as getting cheaper drugs into peoples hands. Sec. Azar innovation is vitally important. That is why two of the key legs of the supplemental request are to develop vaccines and therapeutics for this novel virus. One of the challenges with hr3 is the sheer amount of money it would pull out of the system. I am not a believer if you pull money out of the drug industry is catastrophic or impossible. The sheer amount would impact the bringing forward of drug therapies for alzheimers, for arthritis, just go through the list of therapies that you need to to incent or you wont get them. Rep. Burgess alzheimers drug that was withdrawn a year ago, i am reading is getting a new look at different dosing schedules. And again, work like that, it is not going to happen if we dont value innovation. Thank you for being here, and i look forward to the second part of this hearing. I yield back. Rep. Eshoo part of the bio defense has also been cut. Glad to recognize the chairman of the full committee for his four minutes of questions. Four minutes of questions. Thank you, chairwoman eshoo. Mr. Secretary, i thank you for appearing before our subcommittee today. I continue to be upset by the Trump Administrations decision to ask the court to strike down the aca in the republican lawsuit that is seeking to declare the entire law invalid. If the District Court ruling is upheld, then the Trump Administration will be responsible for the largest coverage lost in history. Over 20 million americans would lose their coverage making lifesaving healthcare unaffordable for American Families. It would eliminate protection for preexisting conditions, adversely affect the Medicare Program and end Medicaid Expansion. I have sent you three letters now including one of april and last year requesting any analysis study assessment with reports regarding the potential impact if the entire aca is founded unconstitutional. And for almost two years now, ive repeatedly asked for any documents relating to any contingency plans in place in the event the aca is found unconstitutional. Only last week i received a one and one and the half page response that answers none of my questions, frankly. Produced soments far to the committee answered none of these questions. I would like to submit, madam chair, my letters and the departments response in the record. I ask unanimous consent. Rep. Eshoo so ordered. Rep. Pallone so really i have two and a half minutes here, mr. Secretary. I think the American People have the right to know what the plans are given the president asking that this entire law be declared invalid. Maybe you just have to answer yes or no. We will see. I only got two minutes. Secretary, has the department conducted an analysis to evaluate the impact on individuals with preexisting conditions and their access to Affordable Health insurance if the aca is found unconstitutional . Yes or no . Sec. Azar it is not going to be left just like that. We would replace with something that replaces preexisting conditions. Rep. Pallone have you done any kind of contingency plan . What would happen if the court struck down the aca . Sec. Azar we are always considering different options. We do if it even agrees with striking down all or part. Rep. Pallone it doesnt sound like there is such a thing. Has a department constructed an analysis on premiums. And access to coverage in the individual market, particularly for individuals with preexisting conditions, if the aca is found unconstitutional . Yes or no . Sec. Azar it would depend on what would be struck down. All, part or none of it. We are years away from a final Court Decision. Rep. Pallone let me ask you, are there any contingency plans to ensure that the 20 Million People covered under the aca do not lose coverage, anything at all . Sec. Azar we have been emphatic that we are changing nothing on how we administer this program during the pending litigation. At the time, if there is a final Court Decision striking down all or part of it, it will depend on the context of that decision and the politics of who is in congress and what we can work with to ensure rep. Pallone i am trying to it sounds like the answer is no. You dont have anything yet. I would just like a commitment from you, basically, to respond to my request. To provide any documents to the committee that relate to contingency plans in the event that the aca is struck down. Can you give me that commitment . Sec. Azar i am sure you will understand that deliberate process regarding legislative proposals are some of the core is the internal executive functions. Rep. Pallone it sounds like the answer is no. I just think that it is unfortunate because our oversight responsibility is to make sure that in the event we have this terrible situation, that there is some kind of contingency plan. I dont think that you have it. I dont believe the administration has any plan. That will occur if this republican suit is successful in court. Thank you, madam chair. Rep. Eshoo the gentleman yields back. The chair recognizes the Ranking Member of the full committee, mr. Walton, for his four minutes. Thank you, madam chair. Mr. Secretary i want to make a , couple of points. The opening day of this congress i led the effort on the house floor, now in the minority, trying to move an effort to protect people with preexisting conditions, pending this lawsuits decision. Congress could act. This house could move legislation to put into law certainty to protect people with existing conditions in addition to the laws already on the books dealing with preexisting conditions. My colleagues have chosen not to do that. So they could. And we would probably find Common Ground here on existing language. There is a lot we could do here. Secondly it was the congressional budget office, independent, nonpartisan, i believe eight to 15 new medicines would never be invented because of hr 3. Speaker pelosis drug pricing bill. As you said, that could be a cure for alzheimers. It could be a cure for the coronavirus. We dont know. That is just the first 10 years. Further out you look, more innovations california life science said upwards of 85 of what they invested would go away. 80,000 u. S. Jobs. 80,000 is what California Life Sciences said. We lose the r d. We lose the innovation. No president ive been around, republican or democrat, ever leaned in harder on issues of costs of care other than President Trump. I was with you and him when he announced the effort to get transparency in the hospital system. And before we got from the News Conference in the oval office, i believe the hospitals have sued you. Is that correct . Sec. Azar i believe it is. Rep. Walden you talked about the drug disclosure in advertising. What happened there . Sec. Azar rather disgustingly, the pharmaceutical industry sued us to conceal their list prices from their consumers. Rep. Walden then i want to talk about medicaid part d. We were all working together on this committee, which we have a great recommendation of doing. Occasionally we fight. That is all right. We know it. We were working together to cap the outofpocket cost for seniors and modernize medicaid part d. When all of that unfortunately came to an abrupt halt, driven i will say from the Speakers Office but we agreed that we needed to cap outofpocket costs. We put that in our bill hr 19. , they put that in their partisan hr 3. We all agreed that it is time to cap the outofpocket costs for seniors in medicare. Does the Administration Support the cost for seniors and medicare . Sec. Azar absolutely. Rep. Walden did the administration oppose hr 3 . Sec. Azar we do oppose hr 3. Rep. Walden does the Administration Support the concept of hr 19 . Sec. Azar we support the elements of it, including capping outofpocket and saving seniors money. Rep. Walden one of the big issues we have dealt with here, or try to, is the high cost of insulin. Not just for seniors, but for others. In our alternative, hr 19, it was all Bipartisan Legislation, we capped the cost of insulin i believe at 50 a month, was the maximum. Does the Administration Support that concept . Sec. Azar i believe so, yes. Rep. Walden so Going Forward, are you hopeful that congress and the administration can get together on a plan to president can sign that can become law, that would actually reduce the cost of the pharmaceutical drugs, in america, without driving innovation away . Sec. Azar yes. I have said the administration is the most flexible party here. Republicans, democrats, senate, house, get list prices under control. Lower outofpocket. Give the real incentive to get drug prices down. Rep. Walden hr 19 contains 80 or 90 of that wydengrassley bill. We think we are with you. We think we can get there. Thank you, mr. Secretary. I yield back. Rep. Eshoo the gentleman yields back. Pleasure to recognize the gentleman from new york for his is it four minutes. Thank you. The state of new york was extremely disappointed to hear that cms has denied the states request for its renewal of the Delivery System reform. When the program was first approved, it was insisted that new york include talk between states Medicaid Program that would incentivize providers to move away from fee for service toward valuebased payments. New yorks Health Care Community has made progress doing just that. Receiving doubledigit reductions and preventable Hospital Readmissions while saving the federal government billions of dollars. That request for additional time and continued investment was to move closer to exactly what cms and hhs have been saying federal government wants everyone to be doing. So in light of that, why would cms and hhs want to stop supporting these successful efforts to achieve the very goals the Trump Administration has been saying it has for healthcare . Will your department commit to meeting with the state of new york to discuss how these reforms are sustained into the future . I would like a yes or no answer, if i could get it. Sec. Azar yes, i am not familiar with that particular program. You are right we do support , the valuebased transformation in our program. I do not know the particulars. Yes, we would be happy to sit with new york. Rep. Walden ok, and i would be happy to sit with you as well to discuss it. Mr. Secretary, we have mentioned it here. Other members have mentioned it here. You know it far too well. Americans are currently suffering from the epidemic of skyrocketing Prescription Drug prices. My constituents always tell me they are having to make unconscionable choices between paying for food or filling a lifesaving prescription such as insulin. House has taken bold Decisive Action to lower drug prices 3 which provides common sense solution by allowing the government to negotiate drug prices. That is a policy that the president supported as a candidate in 2016 saying, and i quote, when it comes to negotiate the cost of drugs, we are going to negotiate like crazy. That is from the president. The administration has yet to deliver any meaningful solution to the health crisis. In may 2018, your department eased a blueprint to lower lower prices, but many of those policies failed to materialize or provide relief to patients. Other ideas such as the International Pricing index has been shown. Despite these, President Trump claims to have reduced drug prices when a recent report shows on an average, drug prices increased by over 5 at the start of this year. Mr. Secretary, can you commit to me that you will deliver on the president s promise and negotiate your prices . I would like a yes or no also. Sec. Azar so we support bicameral Bipartisan Legislation , that would get through. There are many principles that the president is supportive of, but it would have to pass both houses of congress. At the moment, hr 3 does not have the chance to see the light of day in the senate. We need to work on something getting through both chambers. Rep. Walden im sure if the president asked Mitch Mcconnell to put it on the agenda, he would. I dont think so. [laughter] there are plenty of things that we have passed in the house that unfortunately the other body has not done, and the president seems to be right along with it. I just think it seems to be another example of the broken health care promises to American People. I just think we need to get those prices of drugs down, and we need to not have empty rhetoric, but true facts. I yield back the balance of my time. Rep. Eshoo gentlemen yields back. Pleased to recognize the gentleman who was the former chairman of the full committee, mr. Upton of michigan for his , four minutes. Thank you, madam chair. Mr. Secretary welcome. , as you know, this committee on a unanimous vote passed when when i was chair. We expedited the approval of drugs and devices, and i would suspect strongly that with your testimony, we had a Record Number of generic approvals as a direct result because of what this committee did. We also added some 45 billion in Health Research over a 10 year span. Frankly, we ask the question of the agency as we work on this legislation, what is it that we could do to help make sure you hit these targets of fast approvals . Whether it was fda, cdc and others, the nih, obviously, they gave us an answer and we delivered. And at the end of the day, for this crisis, we are going to find a vaccine to solve coronavirus. I would like to think what we did on this committee and what we passed on the house floor will be a direct result of that. And it prompts all of us to ask the questions of what more can we do to get on a faster pace to find that vaccine and that you that cure . Know, diana and i are working on a bill where we can take these three years since president obama signed the bill into law and ask those questions to see what constructively we can do so that all hands are on deck. I know, dont have to ask you, i know that you will help us with ideas to do that. The question that i have is a containment in the first, the very first in responding to any outbreak in coronavirus. We have seen that around the world did i have statements from yesterday that indicate that the cdc says it really is not if, but when. It gets to a larger number of states here in the United States. I always believed in the adage if you are going to do , something, better do it right the first time because you will not find the second, and you want to make sure pay me now or pay me later. So we need to have the right numbers as it relates to this relates to fighting this terrible disease. Is it 2. 5 billion, is it a floor . Is that a suggestion . Sec. Azar we have described the request of at least 2. 5 billion for 2020 money and then work on 2021 money as we see the situation develop over the weeks and months ahead. Rep. Walden i know we are waiting to see the precise details of where it is going. Are any of those dollars envisioned to include the continuancy of what china has done as it relates to regional quarantine . Sec. Azar no. We do not envision that as a kind of practical step here in the United States. As the doctor spoke about yesterday, in the event that we had Community Level outbreaks, which might be small, just a town or city, if we have that, we would take the pandemic playbook which is communitybased mitigation steps, social distancing. It is very rare that those types cordons efforts around , cities, they usually provoke more panic and cause people to actually leave and spread. China is a different government and culture than we have here. Rep. Walden of the 14,000 americans that have died this flu season, do you know what percentage of those were not vaccinated . Sec. Azar i do not have the numbers. Historically, our youth that i that have died have not been vaccinated, which is a real tragedy. Rep. Walden last question. Is there any query of those 55 americans who have currently been diagnosed with the coronavirus, did any of them have the flu vaccine . Was that question asked of any of the 55 . Sec. Azar i do not know if that would have been asked. We do not have any evidence that the flu vaccine would have any properties related to the Novel Coronavirus. I do not know if that was asked as part of intake for the patients. Rep. Walden i yield back. Rep. Eshoo the gentleman yields back. It is a pleasure to recognize the gentlewoman from california, ms. Matsui, for her four minutes of questions. Thank you, madam chair. Thank you for holding this important hearing. Welcome, mr. Secretary. I do want to express my deepest concerns about the medicare, medicaid and other cuts included in the budget. At a time with the coronavirus outbreak and addiction crisis, a lawsuit threatening protections for preexisting conditions. Administrations cuts target the most vulnerable in our communities and access to Vital Health Care services. We should be prioritizing primary comprehensive care, particularly in the mentally ill and people with addiction. I believe Mental Health is an area where we have an opportunity to Work Together and make progress. Mr. Secretary, i appreciate the strong support of the Community Behavioral Health Clinic medicaid demonstration. As you know, a representative and i are working to further scale the program with our Bipartisan Legislation. Mental health and Addiction Treatment expansion act. The eight states currently participating, we have studies showing that quality Mental Health services, Outpatient Care and Addiction Treatment provided at these facilities are saving lives and money. People are avoiding jails in Emergency Rooms instead of getting the comprehensive care that they need in these communities. We have 11 additional states that are ready to participate in an expanded excellence program. Our bill has a bipartisan beard supporting this full expansion. The house has already voted to extend the program longer term. I am very pleased to see that the budget this year explicitly endorses extending this excellence demonstration. I believe that we all agree, mr. Secretary, that adequate resources around treatment will be the center to finding the Opioid Epidemic. Mr. Secretary, i have a question. Under the leadership of the chair, 200 million are made available to hhs in fy 20 to help states prepare. How does hhs plan to obligate these resources . Sec. Azar thank you for your first, personal leadership on the certified committee to behavioral center. You are right. The data is showing really positive results today. Thank you for that. In terms of your work with the chairwoman deloro, now accepting applications from states for these grants to increase access to and improve the quality of Community Mental and Substance Use Disorder Treatment services through the expansion of and the deadline for states to apply is march 10. Rep. Matsui ok thank you. ,the positive impact make it clear that there is room to improve Mental Health and addiction care in this country by scaling this program. Our countyia, hospitals and epidemic centers and public Children Hospitals relying upon Financial Arrangements that levy public funds and partnerships as essential needs providing healthcare to the most underserved communities and patient populations of the state. I have concerns about the administrations recent proposal to eliminate these sources of funding, particularly, supplement payments. I worry that if finalized, the medicaid rule would destabilize the whole system of care provided under medicaid. Payments components of total medicaid reimbursement that was provided to rely on for adequate reimbursement and financial stability. Mr. Secretary, have you waived the restrictions on supplemental payments against the adequacy of these base payments . Are there plans to make any corresponding adjustments to base payments for these providers . Sec. Azar we are hearing the very important feedback from you and others about that regulation. We want to take that in as we look at how and whether to finalize the relationship of these intergovernmental transfers to supplemental payments and also if there are ways we can work with states to restructure payments that would be consistent with the law. We want to work with the states, not be adversarial to them on this. Rep. Matsui thank you. I yield back. Rep. Eshoo gentlewoman yields back. Please to recognize the gentleman from illinois. Thank you for being here. The coronavirus is a novel pathogen, as most of us know. In your testimony you also mentioned an emerging microbial threat. Madam chairman, i ask to submit a record to this, this news a healthrom organization on the 17th of 114thy 2020, and in the congress, i joined with jean greene on what we call the adapt act. Last congress, it was tony i with the help , of the now chairman of the subcommittee and Technical Assistance by hhs on what we call the revamp act. And it was it is an attempt to , address how we have these Antimicrobial Resistance. How public funding may not be the only way you can address this. Can you talk about that challenge . Sec. Azar yeah, i am very concerned about the Drug Development on Antimicrobial Resistance in terms of creating a sustainable market. We have had tremendous success you have led and the congress has led and my agency has supported. We supported 19 antibiotic for three have come to market. There is a market failure question here, where you are basically asking a company to develop a drug and not have it used much. That is not the usually Sustainable Business model. I have asked my team how can we solve that . Is it like a biochemical terror countermeasure . Quite concerned about this. Rep. Matsui that is what that is what we have tried to do legislatively. There were trade deal vouchers, which should have legs in this concern of trying to have something on the shelf you dont want to use. Scott peters and i are also working on legislation that we call ending the diagnostic odyssey, and it is an attempt to to help dna sequencing so that when theres a disease or some event, you dont have to test, test, test. You can go just through the sequencing aspect of that. Any thoughts on or comments on what you all may be doing that we dont know about in trying to push more dna identification . Sec. Azar so i have not studied that particular issue. Were happy to get back to you on that. Its certainly at the fore right now as we deal with the Novel Coronavirus and have the cdc diagnostic but also hope commercial innovators will develop physician bedside diagnostics for rapid insite testing. Rep. Shimkus yeah, and this time the timing because of the threat we are concerned about now but it is also rare disease week and a lot of that community is looking for this as a novel way especially on that , what we call that diagnostic odyssey where they just and we see that with people who are struggling with just types of cancer and trying to identify the right treatment early versus what i would say sometimes is a trial and error method that is very damaging to the health of the patient. And with 30 seconds, let me i wanted to just briefly and its been asked a little bit before. You all do support medicare d reform, is that correct . Rep. Shimkus sec. Azar oh, absolutely. It is a real opportunity for seniors. Rep. Shimkus and how would reform lower patient out of pocket costs . Sec. Azar well, you would cap catastrophic payment, the limit at 3100. So a patient would never pay more than 3100, and then at least the Grassley Wyden plan, the senior could actually opt into a program where they would pay no more than 258 a month for their drugs no matter what their expenses are. Rep. Shimkus amen. Rep. Eshoo gentleman yields back. The gentleman from maryland, mr. Sarbanes, is recognized for his four minutes of questions. Thank you, madame chair. You certainly know the popularity of ecigarettess that has recently led to unprecedented surge of Youth Tobacco use, and it is bringing back with a vengeance the tobacco epidemic in this country we have worked so hard to curb. It shows why we have to improve the law, and something that this committee has been working on. Unfortunately, the Trump Administration is now proposing, as i understand it from the budget, removing fdas oversight of Tobacco Products in favor of an untested agency that will take years to get off the ground which threatens to set us back even further. I am perplexed that the administration would decide to do this, remove fdas authority, alter the agencys Public Health mission, which includes making, quote, tobacco related death and disease part of americas past and not americas future, and by doing so ensuring a healthier life for every family. This latest move is kind of breathtaking. Youth are becoming addicted. In january, after heavy lobbying from big tobacco, as we understand it, and the vaping industry and listening to partisan political consultants, like Trump Campaign manager brad parscale, the administration reversed course, and we were on a trajectory where we thought everybody was on the same page. The administration reversed course, announced a policy which failed to ban all flavored ecigarettes allowing popular menthol cartridges to stay on the market and allowing all flavored disposable ecigarettes and open tank ecigarettes to proliferate through our Nations School yards which is exactly what they are doing. I am concerned removing this authority from the fda, which is part of the proposal, would lead to even more loopholes and industry influence. My question is this. When formulating the Budget Proposal to remove the fdas tobacco Oversight Authority, did you, your agency staff, white house staff, or staff of the office of management and budget speak or meet with any lobbyists or other representatives of the tobacco industry, or for that matter political operatives who work for or are contracted by the president s Reelection Campaign . Sec. Azar well i certainly i , cant speak for others. Im not aware of any such deliberations. The idea was that if we move the Tobacco Center out from under fda, first, if it were a politically appointed a president ial appointed Senate Confirmed leader, they would be more accountable to congress. Second as a direct report to me or whoever is secretary, elevating the role of Tobacco Control there. Its always been a little bit of an odd connection. Fda is about safe and effective, whereas the Tobacco Center is about regulating a product that is undeniably bad. And so theres it doesnt rep. Sarbanes it doesnt make any sense, does it . We are at the height we are at this Tipping Point in the epidemic when it comes to vaping. There does reside, however you want to sort of carve up what you consider the appropriate mission of the fda to be, there certainly exists, resides within fda now, significant expertise and experience in terms of dealing with this issue. Why you would propose at this moment in time when this epidemic risks in a sense overtaking the dimensions of the previous tobacco epidemic that we saw in this country, by zeroing out that authority and moving it to an untested new agency, which by the way, i think would be more susceptible to political influence of the kind i was just recounting than it is now. It doesnt make any sense to me. I urge you to reconsider that. We are in the midst of this crisis, and we have to use every tool available to us here in the government to respond to it. With that, i yield back. Rep. Eshoo the gentleman yields back. There is five minutes and 22 seconds left on the clock. Any member that would like to leave to vote, when we get to you can leave now. When the clock goes to zero, they will hold the vote open for those that have not arrived from our subcommittee, and at that point, well take a 20 minute break, but now i would like to recognize the gentleman from kentucky, mr. Guthrie, for his four minutes of questions. Thank you, mr. Secretary. I look forward to getting to the coronavirus in my second round of questions. The support act we passed last year included my bill, of comprehensive opioid recoveries act, to establish Treatment Centers that offer fda approved medications, treatments, all of them comprehensively. Currently the Grant Application is open for entities to apply. Im glad hhs is moving fast in implementing the program. My question is, how is hhs implementing other parts of the support act, and does hhs conduct any oversight on how the funds are actually being used . Sec. Azar so first, thank you for the support act. And it is so comprehensive, we actually established a support act implementation Leadership Committee to track all of the different work streams needed under the support act. It is really enhancing all five elements of our strategy on opioids. And so, we are just were , driving forward, making progress on the Opioid Epidemic. We have got the Overdose Deaths are down for the first time in decades as a result our collaborative bipartisan efforts here. Were implementing and using the support act authority, so thank you for those. Ok, thank you. Also in 2018 Congress Passed my bill, the bipartisan bold infrastructure for alzheimers act. Can you please provide an update on how this law is being implemented across the country . Sec. Azar so with that act, i would if i could get back to you in writing on that, i dont details on that particular program. If i could get back to you . Rep. Guthrie thank you. This is kind of technical from my role as ranking republican on the o. N. I. Subcommittee for this committee. This committee and o. N. I. Conducted extensive oversight cybersecurity at hhs including through technical audits conducted by gao of cybersecurity controls at hhs operational divisions. That sounds technical. Last congress, the subcommittee on oversight investigations held a closed hearing in part because hhs failed to properly identify and address certain vulnerabilities. We received preliminary results from the most recent audit of another hhs agency, though i cant go into details in this setting. So my question is, does hhs have a point person who coordinates corrective actions on cybersecurity among all hhs agencies, and if so, we direct that person to continue to work with the committee on improving enterprise cybersecurity at hhs and ensuring that mitigations applied in one setting are consequently applied to all hhs . Sec. Azar yes, we do. Our chief Information Officer jose arieta works directly with me absolutely is in charge of those issues. If i could go back to your previous question, i misheard on the bold act. Rep. Guthrie on the bold act, yes. Sec. Azar i apologize on that. For fiscal year 2020, cdc will have two funding opportunities to caret actions under the bold act. There will be the Public Health first programs to address alzheimers disease and related dementias. And second there will be the centers of Health Centers of excellence to address alzheimers disease and related dementias. We expect both of those funding opportunities to be out in the coming month. And for fy 2021, the president s budget for cdc includes 3. 493 million to continue to support these alzheimers activities. Rep. Guthrie because by 2050, thats when i will be 86, i believe, they believe it is going to be estimating cbo, 1 trillion spent on alzheimers disease. Not only is it devastating to the individual, as the family that cares for that person, but also it would be devastating to the deficit and the budget of our country. So this is something very important. Thanks for your leadership and effort. I appreciate working with my colleagues here to move the bold act forward and address it. I yield back. Rep. Eshoo gentleman yields back. Pleasure to recognize the gentleman from new mexico, mr. Luhan, for his four minutes. I will wait right here with you and then we will run over. Thank you, madame chair. Secretary, when donald trump was running for office, four years ago, he famously said that he wouldnt cut medicaid. He didnt say it once or twice, but claimed it at least five separate occasions that he would not cut medicaid, but in reality no president and no administration in the last 50 years has done more to undermine medicaid than donald trump. In fact, his first major legislative effort to repeal the Affordable Care act would have ended medicaid as we know it and put the healthcare of 70 million americans at risk. And if my colleagues from the other side of the aisle want to protect people with preexisting conditions, they should drop the lawsuit. That could happen tomorrow. After President Trump failed to cut medicaid legislatively, he decided to try the same thing administratively, even though the law clearly does not allow it. Secretary azar, theres been some misreporting that the block grant guidance is limited to adults in the expansion population. But under the administrations guidance, states could block grant medicaid for more than just expansion adults. Isnt that true . Sec. Azar congressman, i dont believe thats the case. I will ask the cms administrator to get back to you on that, but my understanding was that it would be an optional demonstration for adults only, and that it would actually not affect coverage for our most vulnerable or pregnant women, children, elderly adults, people on the eligible on the basis of disability, but i will ask the administrator to get back to you on that. Because that is not my understanding. Rep. Lujan let me jump into this, because im glad you pointed that out because i believe that there is a concern here, and i hope that you would agree with me, if thats your understanding, that you do something about it, mr. Secretary, because the center or center on budget points out that people that are low income parents, women who are pregnant, and people with disabilities who are covered through Medicaid Expansion could be included in what i will describe as the president s illegal block grant guidance. Is that something that you would agree with . If thats the case, would you stop it if in fact the guidance does allow for those vulnerable populations to be discriminated against . Sec. Azar so i have been under the view that it does not affect coverage for our most vulnerable populations. It doesnt allow them to strip benefits, strip eligibility, essential Health Benefits have to be covered. You cant change eligibility. You cant cap or limit rep. Lujan mr. Secretary, if i may, just for clarification, because it sounds like were on the same page. Sec. Azar what youre saying im not the concerns you are expressing i dont believe are in the hoa. We will get back to you on that. Rep. Lujan mr. Secretary let me , ask you this pointed question. Sec. Azar yep. Rep. Lujan if in fact the president s medicaid block Grant Program does allow for those folks to be thrown off and get caught up in this, will you stop it . Sec. Azar well, were not going to approve plans that allow people to be thrown off because it cant change eligibility. Rep. Lujan let me ask the question one more time. It sounds like you are getting there. [laughter] rep. Lujan mr. Secretary, if in fact vulnerable populations, like pregnant women, families, those that are disabled, are subject to this rule, where they could be block granted, will you stop it . Sec. Azar i dont believe i will not approve a plan that removes coverage for our most vulnerable citizens. Rep. Lujan so thats enough for me. You said you will not approve a plan sec. Azar with very low income parents, pregnant women, children, elderly adults, or people on the basis of disability should not be removed should not be affected in terms of their medicaid coverage is what im informed. I will get back to you to confirm all those details. I want to make sure im right on that, but thats been my understanding of the hoa program. Rep. Lujan what im looking for is assurance that what if my comments are associated with being consistent with the center on budget points out, you in fact will not approve that plan and you will not allow for medicaid block grant cuts devastating cuts go into place that will be subjected to pregnant women, families, and those with disabilities. Sec. Azar the categories that i mentioned before are ones that i do not believe are subject to it, and plans should not be approved if they would harm eligibility for those individuals. Rep. Lujan so if the center on budgets assessment is correct, you will not allow that to go into effect. Sec. Azar i dont believe their assessment or description of the program is correct. I have said i dont expect that i would approve any plan that would harm our vulnerable populations. It is a healthy adult opportunities under Medicaid Expansion. We will get you any clarification on that afterwards. Rep. Lujan thank you. Sec. Azar thank you for raising that to me. Rep. Lujan theres a reason that most of us in this congress have opposed medicaid block grants. These are devastating programs. Its another effort to undermine medicaid and to continue to cut the program which President Trump promised he would not. This is another example of where he is, and with that, i yield back. Rep. Eshoo the committee will now recess for approximately 20 minutes, so hold on to your seats while you stand up and stretch, and we race over and come back. Sounded like the secretary said yes [inaudible]. [gavel] rep. Eshoo the subcommittee will come back to order. Thank you, dr. Is our, for patience. For your i would like to recognize the gentleman from virginia. Thank you, madam chair. The president and your agency have expressed concerns with a middleman in the drug supply. Hain over time, they have morphed into a deregulated entities from with opportunities to exploit their position in the middle of the drug transactions in the u. S. According to a new report from a consulting group, they benefit from a fee known as direct and indirect remuneration. I know you are familiar with that. At a reading exceeding 500 per prescription. Last year the Administration Proposed a rule to address these but later withdrew it. Do you still have plans to implement Accountability Measures for pbms . If so, what does that regulation look like . Sec. Azar i remain very concerned about the d. I. R. Fees and their impact especially on americas Community Pharmacists as well as independent specialty pharmacies. So the reason that we did not finalize that rule, and we are very transparent at the time, is the concern that if we forced the d. I. R. Fees to basically go through to the benefit of the patient, that that could cause an increase the middlemen would jack up the part d premiums for our seniors, and that was the concern. The president has been adamant that he does not want to run the risk of part d premiums going up. We so it remains a priority for the administration to deal with this issue. If we ever could legislatively, that would be that would be useful, also. Rep. Griffith and as you know, i would love to have a legislative solution, but we thought this might be a good test case to do it with that. Sec. Azar maybe even through if we could get bipartisan drug pricing legislation, that might be a vehicle to have that in there. Rep. Griffith it might be. Let me ask you this, theres been some mention earlier today of hr 3, i raised the concern and then later it was raised by the Congressional Research service, that the bill as written is just blatantly unconstitutional. Have your lawyers advised you that thats the case in their opinion as well . Sec. Azar ive not had anyone study the constitutionality issues on hr 3 about the penalty amounts and whether that would work. So i havent seen any analytics on that. Rep. Griffith any time they want a discussion on it, im more than happy to facilitate one. Lets talk about opioids. I only have a little bit of time left. Over the past few years, there has been a lot of talk how they are prescribed in america and how pain is medically managed in general. And i will tell you that i thought we were on the track of getting our Healthcare Professionals to back off of giving out so many opioids for pain, but i have a friend who is currently undergoing some procedures, and we were talking yesterday about how they had given her opioids, how she took it in the initial day after some painful procedures, but that after that, she turned it away, but they but shes got it sitting in her house. What has this administration and hhs done to reduce the overprescribing of opioids . Sec. Azar so we have actually through the cdc put out guidance to professionals on opioid prescribing. We continue to work on titrating to different pain areas, the best guidance to do that. We have seen and 25 , i believe, maybe 30 decrease in the opioid prescribing of illegal opioids to date, so we are making progress. It is disturbing to hear any pockets like that. Rep. Griffith it will take time, but we cant just because we started to solve a problem, we cannot think that it is sold and we cannot take your foot off of the gas pedal to try to make sure that we dont over prescribe. Then we deal with this very serious issue. It is serious in my district and many others. I yield back. Rep. Eshoo the gentleman yields back. The chair is pleased to recognize the gentleman from oregon. Thank you very much, madam chair. Thank you for being here, secretary azar. I appreciate it. I am going to leave my coronavirus questions to the next panel, but we do want to make sure the cdc is fully funded and a little concerned about the original budget. Glad to see some changes coming forward. My first question is on Medicare Advantage. It is a huge program in oregon and many many states. ,leverages our federal tax dollars to maximum advantage. Oregonians most , seniors, and a lot of their Prescription Drug from the Medicare Advantage pretty very advantage. Very concerned that this administration and others have didnt you try to merit Medicare Advantage programs. I think its foolhardy, the whole goal here is actually make sure the savings are piled back in to make sure there are more benefits that are covered, better Prescription Drug coverage and expanding it to a larger universe. So could you give me some assurance you are going to continue to this administration, you will try to improve the Medicare Advantage program and not take away the savings that can be plowed into more savings for folks . Sec. Azar absolutely. Im actually have direct orders from the president to protect that. Exactly the things you were talking about, offer more supplemental benefits, make sure those people have attractive options as possible. Rep. Griffith i saw guidelines in reducing caps and that sort of thing, made me nervous about the intent was. Second question is on the proposed medicaid rule. You hear a lot about that back home. Many states, i was budget chair for my state back in the day. It seemed like a great opportunity for states to again leverage federal dollars with the state tax dollars, actually with private hospital dollars in longterm care dollars. It was a really smart use i thought of taxpayers limited ability ability to finance programs they want. This really made great use of the dollars. Very concerned with this new all that ostensibly, with the respect, it is in the guise of transparency when indeed its back to take away patching funds matching funds and the ability for the provider tax be given the fact that the executive order requires agencies to perform this Impact Analysis to determine the effect of the impact of the proposed rule. From the implementation of the proposed rule is unknown. Do you consider that to be a comprehensive analysis . Sec. Azar i dont know the specifics on that. I do want to assure you we are hearing the feedback from you and others and governors about this. We are looking at this to make sure those intergovernmental transfers are genuine state money that is being matched and not funny money or schemes. Appreciate getting his feedback. We are hearing a lot of it. Callat some people would be usingey would Accounting Systems at maximum advantage. I urge you to back down on that a little bit or give it some more serious thought. I yield back. Rep. Eshoo it is a pleasure to recognize the gentleman from florida. Thank you. Zar, thank you for your leadership and your responsiveness. Progressegun to make in tackling our nations Opioid Crisis and hhs has played a key role in that effort. Thank you for your continued support, of course. Has theeel hhs necessary resources to continue to implant provisions of the 2018 support act and the 2019 hhs Pain Management Task Force Recommendations . Sec. Azar we have increased funding for opioids in this budget. Very good. The funding is expiring soon. We reauthorized it for an additional seven years and that is a great thing. Centersommunity health serve as a gateway to integrated care for individuals with Mental Illness and Substance Abuse disorders . Sec. Azar more than 28 Million People rely on community Health Centers. They are critical part of our primary care network. We are using them as part of the ending the hiv epidemic program. 93 of our 1400 Health Centers provide Mental Health care and treatment. 60 of the clients at community Health Centers are ethnic and racial minorities. I am so impressed when i visit them. The quality of care and service. Absolutely. Do you have anything to add . This is a big issue affecting our constituents on the insulin pricing. This has been mentioned in committee. If you could elaborate on that, i would appreciate it very much. Sec. Azar i did want to clarify one thing regarding a piece of legislation i misheard a proposal to cap outofpocket for insulin. The administration does not have a formal statement of position on that piece of legislation. We want to get out of pockets down. We want to deal with the insulin issue. We dont have a formal statement yet on that issue. Part d reforms the committee has worked on, a lot of bipartisan support, that could be such a benefit to people. Spreading the cap over 12 months were no senior would ever pay more than 258 a month. What an incredible thing to deliver for seniors. We will follow up with you. How does the budget affect School Safety . Address School Safety and the Mental Health needs of our students . Sec. Azar we fund project aware, which is a School Safety program for Mental Health services. We have healthy transitions funded which improves access to mental Disorder Treatment. We have the safe schools framework implementation toolkit to help educate teachers and administrators to identify kids in crisis. Thank you very much. Rep. Eshoo the gentleman yields back. Recognize the gentleman from massachusetts. Week, dhs, lamented their test for immigrants nationwide. Testplemented their nationwide. Many of whom are legal immigrants. Nearly 5 Million People are forced to forgo their Health Coverage. Is that a success . Sec. Azar we do not believe that refugees . Sec. Azar we do not believe that individuals who come to this country to be dependent on Public Welfare programs. You have free and lee told the story of your grandfather you have frequently told the story of your grandfather who arrived at ellis island who spoke no english. You speak probably of that story. Under this role, based on your own telling of the story, your grandfather would have been turned away. Are you proud of this Public Policy . My grandfather worked his way would he have had access to health care under this policy . Sec. Azar he would not have asked for it because he wanted to make his own way. You are proud of this policy . Sec. Azar i am proud of my grandfather. Dr. Fauci that is not that is not the question. Sec. Azar the American People do not support the idea that people should be coming to this country people withoutf health care has risen. Sec. Azar the numbers on the uninsured require a bit more depth than that. Aca,is happening is the most of the growth is because the aca priced individuals out of the individual market. That theu aware percentage of uninsured children rose by. 6 under your leadership . In terms of children and coverage, we have reauthorized that for a long period of time. We have the Medicaid Program. In terms of the uninsured numbers, the children who are uninsured are likely part of the coverage gap left by the aca. Month, weieve last held a hearing about an Opioid Epidemic where a representative stated if North Carolina had expanded medicaid, 415 more people would be alive in North Carolina today. Do you believe this administrations opposition to Medicaid Expansion has cost lives . Is that a good policy choice . Sec. Azar i will not validate that politician statement. A representative of the department of health and Human Services. You are unaware of the fact that medicaid has saved lives in North Carolina . Sec. Azar i have not seen the evidence basis for the assertions you are making. You have spoken about this administrations efforts to combat the coronavirus. Prepared after developing flulike symptoms following a trip to china. He was left with a bill of well over 1000 and the demand that the proof that the condition he was tested for was not related condition. Existing do millions of people who have signed up for junk insurance plans, do they have a choice . Sec. Azar the Short Term Limited Duration plans are an option for individuals. They may be the right choice but they may not be the right choice for others who have preexisting conditions. Leaving people with thousands of dollars of uninsured claims in the midst of a pandemic. If it is a choice between no insurance and some insurance 60 lower, it is an option i yields back. Rep. Eshoo the gentleman yields back. Pleasure to recognize the gentleman from indiana. Thank you very much. Thank you, mr. Secretary. I will switch gears a little bit. 340 b is a Critical Program for rural hospitals and im interested on what you think should be done, if anything, to continue to ensure the program, given its Significant Growth is helping more patients get access to care. Sec. Azar you put your finger on it when you mentioned the growth. It has grown from 7 billion of pharmaceutical sales in 2012 to 19. 3 in 2017. We do believe those savings need to make their way to patients. Not just subsidizing hospitals. Imagine, take the issue of insulin. Hospitals acquire their insulin at an extremely low price but they dont have to pass those savings on to the patient that they are serving as an outpatient. That is partly why we would propose the changes that would reduce what seniors have to pay for part b in the Medicare Program. Do you think more transparency would be part of the solution . Sec. Azar absolutely. We support transparency. We support giving the Regulatory Authority and requiring that hospitals that want to get the benefit of those savings i just talked about to retain that in the program would have to dedicate 1 of their work toward delivering charity care. What you are saying is that they need more authority and more teeth. Sec. Azar we need greater oversight and Regulatory Authority to implement the oversight. Audits in an enforceable way. I would also like to thank you for making improvements in Pain Management. I firmly believe we will never successfully address the Opioid Epidemic unless we address Pain Management. Patient access to nonopioid therapies, especially fda approved devices. Can you tell us what hhs is doing to promote Pain Management best practices . To break down barriers to nonopioid therapies . Sec. Azar one of my Top Priorities has been to leverage that is why we adopted the mom model. It will address the fragmentation of care for postpartum pregnant that is part of that. Earlier in the hearing, you were starting to give some bullet points on corona. The fivepoint plan or whatever. Can you expand on that . Sec. Azar expand our surveillance system. Comparable to what we have on the flu. Money to support state and local Public Health department. Vaccine research and development. Therapeutic research and develop. Strategic National Stockpile acquisition of personal protective equipment. Do you feel we have had enough access in china to get the data that we need to help solve this problem . Sec. Azar we have struggled. The World Health Organization has completed its mission and we are awaiting its report. Resortso see the final the final results of that. For the record, hhs has existing Oversight Authority of 340 b and it is my understanding that they have conducted 1500 audits of the program. Sec. Azar the courts have said we do not have the ability to implement regulations. Dr. Redfield we are talking rep. Eshoo we are talking about audits. Look at your audits and see what is in them. It is under the control of your department. I would like to call on or recognize the gentleman from california. Much. Nk you very i appreciate the opportunity to have this oversight hearing. Thank you so much for being with us. An opportunity for us to ask you some essential questions in fulfilling our oversight duties. Last time you were here, i ask you about your agencys role in the horrifying practices of separating children from their families. I would like to ask you of other ways the administration is impacting families in my district and throughout the country. I would like to ask you about an issue that is frightening families in my own district. Im a talking about the wants to use our federal tax dollars to put a facility there to have children in prison like setting. Vision quest, the company that received these funds, has a history of alarming reports and stories of abuse within their programs right here in this country. These stories include descriptions of excessive use of physical restraint and isolation, verbal abuse, food deprivation, humiliation and intimidation and even death. This is all about them having children in their care. As part of the Due Diligence of your organization, what officials within the office of Refugee Resettlement be aware of these types of violations before awarding a contract to such a company like vision quest . Sec. Azar i dont want to endorse the statements that you made about that entity. I want to be careful that i am not endorsing them. I would expect that it would be part of any grant review for any grantee to examine their past history. If you could report to this committee if any of the grantees such as the one i was talking to, if there is any evidence within the department, any valid situations with an organization such that would be entrusted with federal funds to house children. These funds that you would be providing, unless you were to have such evidence, you would go ahead and contract with an organization . Sec. Azar that is how the unaccompanied alien Children Program runs. Until we canees place them with sponsors. That is the System Congress set up. The city of los angeles is in the process of solidifying their ordinances as to whether or not they will allow private entities to use federal funds to house children. I have another issue. I want to turn to the issue of impacting American Families, especially vulnerable children. You speak about the importance of promoting adoption to give children the stability and love during her childhood. You speak about prioritizing adoption but you neglect to mention the fact that right now, in america, the agencies are turning away qualified potential parents because they are either lgbtq or happen to be of a religious minority. This is in spite of the fact that lgbtq parents are seven times more likely to foster or adopt children then nonlgbtq parents. In your efforts to identify and address barriers to adoption, can you tell me how eliminating Data Collection and reporting on Sexual Orientation is helpful to furthering that goal . The original regulation contained 270 individual data points. The states, significant feedback about the volume of Data Collection. All of which is money is if we add more questions, that is money the states cant use to assist with adoption and foster care placement. This is an effort to streamline those data requests. Rep. Eshoo i think the gentleman. Pleasure to recognize the gentlewoman, and that she is, from indiana. Thank you, madam chairwoman. Thank you for being here. Out that for pointing just this past june, the president signed the reauthorization of which this committee worked very hard on and we finally got it done. With thehard chairwoman and the Ranking Member of this committee to try to make sure we improved our readiness and response and because the question of a pandemic is not a question of if but when, most people and the cdc is acknowledging that. One thing i would like people listening to understand, the global security, Global Health Security Index was recently issued and the United States was first in the world out of 195 countries for prevention Detection Response and Public Health. I want to commend the administration for the strategy that was put in place for 2019 2022. With respect how are you leveraging, how is hhs leveraging all of the new things that we put into it . I would like to ask you to address there are so many good things in your budget, but i am concerned about a 200 million cut to barta. It is brought forth so many incredible innovation. What strategies are we going to put in place . Was in thethat budget before the coronavirus situation. Because congress and the addedriations in december 535 million to the ebola funding available, we were pulling forward some of our Acquisition Strategies into 2020 around vaccine and therapeutic on ebola. That created some offset. We may need to relook at that now. Weas meant to be pulled forward some of those Acquisition Strategies. The private Sector Companies who are our partners, and because the government is the customer for those products, is they shoulday that not anticipate with what is happening right now a cut in their funding . Withazar is we would work we would work with the appropriators in which the offset we proposed i can tell you that feedback this morning, i think that may be unlikely. We still have ebola in africa. Sec. Azar it is definitely on the downswing. We would use that money for acquisitions on ebola. If that money remains there for ebola vaccines. If not, we would work with appropriators to make sure it is adequately funded. Are there any other strategies or framework we provided that you are using specifically right now to combat the coronavirus . Sec. Azar on the coronavirus, i cannot trace directly are vaccine strategies are very much influenced our vaccine strategies are very much influenced. As well as cellbased technology. I yield back. Rep. Eshoo the gentlewoman yields back. The gentlewoman asked about the 200 million cut. The secretary responded. The administration, mr. Secretary, put out the budget 10 days after, not before, after declaring a Public Health emergency. Your answer is really not correct. Sec. Azar the budget is locked in december. It was probably printed. Administration does not have the ability to cross something out and say we are not cutting this . Come on. The gentleman from vermont is recognized for four minutes. Thank you, mr. Secretary. Drug importation, we are very happy that you put your proceeding on that. We have a republican governor in vermont who was extremely interested in getting Authority Hope to haved they everything that is required for you sooner than the deadline. We think it is a great opportunity. Our republican governor and Democratic Legislature wants to take advantage of this. One of the concerns the governor has is insulin and that is not included. My understanding is that there have been some concerns raised as to whether that can be safely done. It would make a huge difference to vermonters. A lot of people already drive across the border to get insulin, and even some companies to that. Our view is that the concerns about safety are always legitimate. No matter where the source of drugs. Our real request is to accommodate insulin as one of the drugs that would be important as long as it is done safely. I wish you could comment on that and tell us what we need to do to give relief to some folks who are desperate. Are expresslyulin excluded. Objection to it. The second part of the Importation Program were a drug company could bring a product in with a new drug code and price price so theylist could deal with those middlemen contracts, that is open for all products. You are saying it is because not because of a concern that hhs has . As far as you are concerned, if you felt there was authority for insulin to be included, you would see no reason to object to that . Sec. Azar that is correct. We would be supportive if the statute provided for that. If we did an amendment to the betute to allow insulin to an exception, you would be supportive of that . Sec. Azar i can tell you the president wants importation and wants it yesterday and we are delighted the governor is working because we want shovel ready Importation Programs so when we finalize a rule, we can get a work get to work. Who would i followup in the ministrations . Who what i followup in the administration . Sec. Azar me. Be huge for the governor of vermont and the people of vermont. Sec. Azar happy to work with you on that, absolutely. Rep. Eshoo the gentleman from georgia is recognized. Thank you, mr. Secretary. Dir fees. Follow up on have squeezed out 4 allion out of pharmacies and survey that was done by the National Community Pharmacist Association said 58 of the independent retail pharmacist do not expect a be in business in two years as a result of dir fees, which should be of concern to all of us and hhs. I wanted to ask you, i believe you responded to mr. Griffith by saying the concern was higher premiums. All of those pbms are owned by Insurance Companies. How can we answer the question of whether those rebates that they are getting giving are going back to the Insurance Companies that is also owned by the same company . Sec. Azar we dont have pbm transparency. We cannot know where those moneys are going. It would appear to me that it is taking money out of one pocket and putting it in the same pocket. The vertical integration is something that has to be addressed. What can we do to address the dir fees . They have been associated with higher outofpocket costs for recipients and that is something we have to be concerned about and i know you are concerned about it. If we can lower outofpocket costs, would it help to have the rebates at the pointofsale . Sec. Azar yes, it would help to have the rebates at the pointofsale. It would lower outofpocket costs. The dir is a penalty provision that the middlemen impose on the community pharmacist. The patient is made to pay off of the full price when they by the drug and the pharmacy later may get this clawback but the patient does not get a refund. Place a yearake after. Sec. Azar very unpredictable to the community pharmacy. You andis time, are others involved in preparing for a potential covid19 outbreak, doing everything you can to prepare for such an event . Sec. Azar we are. If you felt like you need more money, would you ask for . Sec. Azar i would have and i have. At any time, if you and others involved in preparing for a potential outbreak need more money, will you ask for . Sec. Azar i will indeed. Is not to say that the amount of money that is asked for is proportional to the effort that will be put forth to prepare for this. Sec. Azar the president has made very clear in my own discussions with him and publicly that we want to work with congress on appropriate supplemental appropriation and at least 2. 5 billion. We need to make sure the congress is satisfied with the funding also. As it should be the case. If you find out that you need more, you will come back to us and we will approve it. We want you to have everything you need to prepare for this. Madam chair, i yield back. Rep. Eshoo the gentleman yields back. The chair recognizes the gentleman from california. You, secretary, for being here today. As a father and a physician, i care very deeply about the physical and Mental Health of children. And also children while in the custody of the office of Refugee Resettlement. I am glad my colleague brought that up because i am dealing with a similar situation in my district. Takes into consideration the unique nature of each child situation and incorporates Child Welfare principles when making placement. Clinical Case Management and decisions in the best interest of the child. Let me get this straight. When determining appropriate housing for children in custody, do you give grants to forprofit organizations with a documented history of child abuse . Sec. Azar i cannot speak to that particular grant. We give grants for forprofit and nonprofit without discrimination. Those with a documented history of child abuse. , youdition to the facility are providing a grant to vision quest. Vision quest is a forprofit organization whose history suggest their focus is to make money rather than care about the wellbeing of children. This is a complete fight this is exemplified by their long history of keeping children in abusive conditions. Reports found the treatment methods used by vision quest were unorthodox and activities engaged posed unnecessary risk. Last year, the Associated Press reported the department of justice documented episodes of physical and mental abuse at a vision quest shelter in staffersnia, including pulling childrens hair, choking minors and slamming them into walls. In 2017, the city of philadelphia had to end a contract with vision quest after state inspectors found that Staff Members had choked, slapped, and injured children in the facility. Providing federal funding to a forprofit entity with a history of child abuse is not in the best interest of children. Sec. Azar i am not familiar with that report. Whether forprofit or nonprofit is not the factor but we want to ure that any grantee [inaudible] rep. Eshoo will the gentleman be seated and speak from the microphone . From 1994 we will make sure any grantee is appropriate. That is why he mentioned a long history of abuse. When you look and review these programs, what is the process . Is there transparency . How do you open this up to communities to determine who is going to house children with the safety of these children in mind . Sec. Azar for these permanent bedded facilities, the grantees would have to be state licensed. There is a state licensing procedure. The state of pennsylvania denied them their ability to take care of children. They had to close that facility. When you look at those reports and you review the evidence, would you be open to reevaluating these grants and your relationship with vision quest . Sec. Azar i will ensure that we have looked at these and this is part of the criteria. Just because an entity all of the behaviors you described are acceptable. Behaviors you described are absolutely unacceptable. Rep. Eshoo we really need to move along because we have another panel and everyone knows it is a very important one. Lets stay with in our time. I want to thank you for being here today. I know we tried to get together one time and as soon as we sat down, my phone started blowing up in my house was on fire in missouri. Turns out it was not. The Alarm Company people seem to think it was. I am sure your mother that. I want to thank you for working so hard to advance the administrations health agenda. Many americans face challenges. Rural healthhe task force. It is vitally important in my area. Can you first speak to the role in identifying the need of rural areas and how to meet those needs . Sec. Azar the task force identified four key priorities. Weve got to develop a sustainable model for Rural Health Care. Second, we have to have prevention and health promotion. We have to Leverage Technology and innovation. We have got to get the next generation of providers out into Rural America and we have to allow Nurse Practitioners and pas to practice to the full extent of their license. Thank you. One area that has been seriously impacted is Durable Medical Equipment. I was pleased that cms issued the final rule in may that provided Payment Relief for Durable Medical Equipment in rural and continued the relief rule until theal end of 2020. Can you tell me of cvs plans to continue cms plans to continue this . Sec. Azar i am not able to discuss pending regulatory action. That remains very much top of mind for us. In the presence budget, there is a provision that would expand the bidding program. We have heard many complaints about Competitive Bidding program. Really since its inception. Can you detail how you would like to reform the program . Sec. Azar what we would like to do in the budget is pay for Durable Medical Equipment under the Competitive Bidding program and moved up from a single payment amount is based on the maximum winning bid to pen suppliers on their own bid amounts and expanding the Competitive Bidding to different geographic areas. We think that would increase access by allowing competition. Solve a lot ofan the access challenges we saw. Ok. Has cms engaged with outside experts on this . Sec. Azar we engage with stakeholders and experts before we consider any new policy. Would you go forward with the proposal without congressional approval . Sec. Azar for some of the regional elements, i believe i dont know if we require statutory authority. If i could get back to you. Rep. Eshoo the gentleman yields back. The chair recognizes the gentlewoman from michigan for her four minutes. I know it has been a long afternoon. It has been nearly a month said you declared a former Public Health emergency in response to the coronavirus global threat. On february 2, he sent a letter to congress that you intend to use your transfer or reprogram authority to reallocate 136 million from current programs. Yesterday, we got the details of those transfers and i would like to request consent to enter that into the record. Rep. Eshoo so ordered. 62 million transferred out of nih, 37 million taken from the low Income Energy assistance program. Given that you plan to take 37 million from the low Income Energy program, do we have any estimates on how many people that will impact or who will go without heat this winter . Sec. Azar for the transferred reallocation, that works out to a. 2 change. We did that across the department evenly. Season,ate in the almost at the end of february. Can we get for the record what we think the impact will be . We are worried about people who will not have heat. I just have to go fast. You are going to be taking you took 62 million from nih. Will that harm our ability to conduct medical research and to do Cancer Treatment . I am happy with you that cancer deaths have gone down this year. What will happen to those programs . , they firethe nih firewalledrtain off. Cut. It has not been you stated in your Senate Testimony yesterday that the u. S. Currently has about 30 million stockpiles and 95 respirators that can help stop a person from inhaling infected particles but it might require 300 million for Health Care Workers alone. This does not include personal protective equipment. 900 more cases worldwide. I am worried about the supply chain. Your own agency has stated the of are manufactured outside the u. S. Yesterday, the Washington Post told us large Group Purchasing Organization Says we may only have a two week supply. I do not want to frighten anybody. Are we facing an imminent shortage of respirators and other personal protective equipment . Sec. Azar i do want to clarify the numbers. I learned some Additional Information about the number of masks. We have a higher number but the mix is different. Million certified masks and 5 million that are not certified. One of the things we are doing with the transfer money is contracting to get contract started with domestic manufacturers of the 95 masks so that we can scale up production. How long will it scale up how long will it take to scale up the production . Isnt it a National Security threat that 95 of our generics are coming from china . What will we do to bring the production of these kinds of essentials to this country . Rep. Eshoo the gentlewomans time has expired. Who is next . The chair recognizes the gentlewoman from delaware. Thank you. Welcome, mr. Secretary. I have to express my deep concern and disappointment in the implementation of the Affordable Care act is the law of the land. It appears that the department of health and Human Services has made it harder for americans to access and afford the vital Health Coverage that they rely on. Your Department Proposed a rule that would discontinue the aca subsidies for low income families who do not actively reapply during the aca open enrollment. Open enrollment period. They are currently enrolled in part your department acknowledges that there are 270 americans who are reenrolled in these zero dollars premium plans that would lose or could lose their coverage. Proposedposed you ending auto enrollment, thereby endangering their coverage. Question, and deciding to propose this policy, did you consider the fact that it would result in American Families losing coverage . Sec. Azar i want to get back to you for the record. I dont know if we proposed it as opposed to ask for comment. For people who are 100 subsidized. I think we asked for comment as opposed to proposing that as the approach. If you are asking for comment, it is something you are considering . Sec. Azar it is under considering it is under consideration if we should require someone to reapply if they have 100 subsidized. Can you guarantee that no individuals will lose coverage as a result of this policy . Sec. Azar if they dont qualify, they would not retain coverage at 100 subsidy. Meaning that if you change the policy, they would not qualify. I am alarmed that your department would propose such a policy given that congress directed you to establish automatic reenrollment for all individuals enrolled in marketplace. That provision was signed into law by the president at the end of the year. This proposed policy goes against congressional intent. This true secretary, will you commit mr. Secretary, will you commit to the American People that you will not take any action that would cause American Families to lose their Health Insurance . Was azar i believe that with respect to 2020 moneys and the request for information was regarding the 2021 plan year. That is my understanding. The deep concern is that the department has a record of refusing to invest in robust advertising and outreach. The department has drastically reduced funding for outreach and education activities. Limited time for enrollment and is giving consumers less opportunities to make informed choices. Threatens totment discontinue American Family subsidies that have become accustomed to being reenrolled each year. Would you commit with working with me to ensure that americans wishing to enroll will be well informed about the opportunities to enroll . Sec. Azar i am always happy to work with you. We have talked about working together before. I just want to put it on the record. Sec. Azar in terms of open romans, we put out in terms of open enrollments, put out a billion reminder emails. We will followup. Rep. Eshoo the chair recognizes the gentlewoman from california. Thank you, mr. Secretary. You, our u. S. From government has implement and aggressive measures to help prevent the spread of the coronavirus. There have been repatriation missions, travel bands, airport restrictions, and additional travel notices issued. Any of these actions have impacted Los Angeles County many of these actions have impacted Los Angeles County. The president signed a proclamation banning foreign nationals from china in the last 14 days and were not immediate family of u. S. Citizens. Over the course of a few weeks, 808 u. S. Citizens were flown back to the United States where they were quarantined for 14 days at military bases. As of today, 37 countries have confirmed cases of coronavirus. Should we expect travel bands from countries like italy who have confirmed cases of transmission butter on a different continent then current but are on a different continent then current travel bands . Sec. Azar it is an excellent question. When we did the additional chinaban, we were very clear. We cannot hermetically seal the United States off. Measures like that would not be effective. With china, with the epicenter being in china, we felt it was appropriate to do their. We will constantly look at other travel advisories. As we gather more information. Is a very good point. Are going torces these quarantines that are happening . Should these be expanded . Sec. Azar i would like to get us out of the quarantine business. I do want to commend california and the local governments. They have been a superb partner. It is quite expensive to maintain institutional quarantine. In the future, we had envisioned more self home isolation activities, state and local based monitoring and quarantine activities. On monday, hhs issued a statement that revealed a naval base in Ventura County may receive american travelers coming through lax who would be quarantined to be monitored for symptoms of coronavirus based solely on their travel history. What are the plans to quarantine americans based on solely their travel history and would those be voluntary or mandatory . Sec. Azar that would be an individual that was in the in hubei14 days province. We are seeing very few of those individuals. We had a family of three and one individual. Conceptmore of a backup , the ventura facility. We have worked very well with the state and locals in california. The cdc has said it is not a matter of if the virus will spread but a matter of when. If Congress Wants to work with your agency, we cannot do that without sufficient funding Going Forward to state and local partners. Thank you. Rep. Eshoo the chair recognizes the gentlewoman from new hampshire. Thank you. Thank you for appearing before committing. Theres a lot going on both in your budget and with our concerns about the coronavirus. I will move through this quickly. The key to a Public Health crisis is trust and credibility in my point it would be helpful for clear easy to understand updates from this administration to both us as policymakers and members of congress and to the American People. It would be even more preferable if the statements by the president did not contradict the statements of the scientists and physicians at the cdc and in your department. On theto jump right in administrations continuing efforts to undermine the Affordable Care act. Your nistration and claims to support protections for preexisting conditions but with all due respect, the facts speak for themselves. If this administration has repeatedly taken action, including court proceedings, to undermine protections for people with preexisting conditions. Your department finalized a rule to expand junk plans that do not provide protection for people with preexisting conditions and issued a 1332 waiver guidance creating new standards and consistent with congressional intent. Simplece states yes or no question, are you aware that the guidance could substantially raise costs for americans with preexisting conditions . Sec. Azar it allowed me to approve reinsurance waivers causing declines in premiums. We approved a waiver allowing hawaii was it a white . That was hawaii. It is a technical aspect of the Affordable Care act. Commit not to approve waivers that would jeopardize the health and wellbeing of the financial the Financial Wellbeing of americans with preexisting conditions . Administration those do indeed threaten and jeopardize individuals with preexisting conditions. Do you think it is appropriate to allow states to direct taxpayer dollars toward junk plans that do not provide protection for preexisting conditions . Sec. Azar we think it is appropriate for states to provide access to the shortterm plans. Under the Obama Administration, the shortterm limited duration plans were three months. You have extended it to 12 months with three renewals. Sec. Azar the Obama Administration had them for up to 12 months up until the very end of the administration when they passed a midnight regulation shortening it to three months. My point is that it was three months and you have allowed for extensions for up to three times. We had people testify that they did not even have noticed that there preexisting conditions were not covered and even insurers that said to them, if they did not know they had a preexisting condition, they should have known. This is something we need much more work on. Correction. Ne 12 reinsurance waivers. Rep. Eshoo the chair recognizes the gentlewoman from illinois. To instruct the members, we have two more to question and they have agreed to limit their time to two minutes each. We will then take a short break, maybe five minutes, to reset the witness table for the next panel. Takellow the secretary to at least a few minute break. We will recognize the gentleman and a woman from illinois. I want to talk about two issues that i have paid a lot of attention to and have that have ravaged communities of color across the nation. President trump has expressed concerns about Maternal Deaths. He called for Bipartisan Solutions to reduce gun violence. We have come up with Bipartisan Solutions. Ive worked with my colleagues on the others out of the aisle on a bill to expand medicaid to provide postpartum coverage for a full year and congress appropriated 12. 5 billion in funding for the cdc. Tor Administration Seeks slash funding. Out funding for gun violence research. Are you aware secretary, are you aware the budget contains a proposal that would allow states that impose an asset tax on pregnant women i medicaid, pages 112 to 113 of the hhs budget and brief . Sec. Azar i want to look at that and get back to you, im not aware of that particular provision. We do have the proposal similar to what you mentioned for medicaid that would allow states an option to cover pregnant women for one year after birth if theyre suffering from Substance Abuse disorder, so thats another part of the Maternal Mortality initiative. That proposal would cut medicaid funding by 2. 2 billion. That would cause a lot of people, including pregnant women, to lose their medicaid coverage. Sec. Azar thats a spending provision, the one i just mentioned would actually expand, right now they can only get 60 days coverage postpartum, this would allow that coverage for up to a year as a state option in a nonneutral way. My time is up. The gentlewomans time is expired. That legislation that we took up here is awaiting floor approval. The gentlewoman has been a leader on this for, long before the rest of the members even knew that we had that horrible statistic in our country. Last but not least, the gentlewoman from florida for her two minutes. The administration is urging the federal courts to strike down the Affordable Care act in its entirety. Including the protections for more than 130 million americans who have a preexisting health condition. I think my neighbors back home would want me to relay to you how dangerous that is, how angry they are about it. They do not want to return to the days when Insurance Companies could discriminate against them if they had asthma, cancer diagnosis, some other preexisting condition. They dont want to return to the days where an Insurance Company can cancel them if they get sick and i think the coronavirus now highlights the importance of consistent Health Insurance oferage that has a floor essential Health Benefits. It really shines a light on these junk plans. Your department has finalized a rule to expand the Short Term Limited Duration junk plan. They are not required to cover preexisting conditions. You acknowledged that in your last Budget Hearing in front of this committee. And a couple of studies have come out recently, a Georgetown Health policy institute study, a one commissioned by leukemia and Lymphoma Society that channels highlights the abuses here. Is the department conducting any oversight on the abuses of these junk plans, the abuses in marketing, false promises, are you conducting oversight . Sec. Azar the Short Term Limited Duration plans are off exchange. We dont regulate them subject to state insurance regulation. You do not. So its like handsoff, you said were going to promote these junk plans and you are not conducting any oversight, is that true . Sec. Azar they are subject to state insurance regulation. You dont check in with the state and monitor the abuses in the junk plan market that are raising costs on everybody and excluding preexisting conditions . Sec. Azar we do not regulate state insurance commissions. Gentlewoman yields back. Lets take a fiveminute break. The staff can reset the witness table. Then we will resume. Thank you. [indistinct chatter] Public Health officials joined alex a czar for the second half of this hearing which focused on the coronavirus and the ability to with respond. And the head of the National Institute of allergy and Infectious Diseases. The subcommittee on health will come back to order. What were going to do is were not going to have our witnesses do their formal public statements. We have them all in the record. We thank you for them. I actively read them and im sure my colleagues have as well. What i want to do quickly out of respect to each is to just give a quick introduction and then we will go to members with their questions. And first of all, thank you. For being here. I think that the United States of america is so blessed, so blessed to have, i think, the finest Public Health professionals in the entire world. In the world, there is a reason why the world looks to us, because we have you and your expertise. Thank you to you. America cant live without you, really. Doctor hahn, welcome to you. I think this is the first time you are before the committee. And we will make it really pleasant for you. We wont do to you what we did to the secretary. Mr. Secretary, welcome back to the table. And to dr. Redfield from the cdc, thank you for being here and thank you for collectively, for what youve done to help to brief the congress during this. Is it my turn to ask . Let me start obviously with the coronavirus. I started out earlier today saying that confusion is the enemy of preparedness. I do not put confusion at the kadlec, of dr. Fauci, and redfield. I think you have done an excellent job in advising, briefing the congress, and for the work that youre doing. I think we have some problems with the administration because the professionals say one thing and then theres confusion on the other side. I hope that Something Else will happen and that the briefings be held in public so the American People can hear you. I hope as we move through this challenge that the American People will come to know you the way we do, and that we elevate the level of confidence and trust that i know you can engender, but i dont think its there now. Theres confusion, markets are roiling. Its not only because of confusion, but there are many matters at hand. But you, the scientists, doctors, the American People couldnt be better served. Couldnt be better served, so thank you to you for your especially Important Service right now. What i want to go to is our drug supply. Are manufacturers being forthcoming with the fda about potential shortages . We are being proactive in our discussions with manufacturers. As you know, drug manufacturers are required to report to us when there are potential disruptions. How far in advance do they let you know that there will be a shortage . Typically those conversations occur in realtime. I know that. I think usually all of our conversations are in realtime. Saying how much in a trajectory of time, if they were talking to you today, would they be able to tell when a shortage would begin . How much runway do we have . For example, china and manufacturing. We have a problem with that. Just as an example i can tell you drug manufacturers are required to tell us when theres a potential disruption to the drug supply. When the applicants apply to the fda, they might provide for example five different manufacturers for the precursor to the junk and five manufacturers for the final drug form. Let me ask you, if the coronavirus outbreak is continuing three months from now and i pray that it isnt, what do you estimate the American Drug supply will be . We have looked at this. There are 183 Prescription Drug manufacturers in china, 20 are source from china. As both precursors as well as the final drug form. Weve reached out to all these manufacturers. We have no shortages for those solesource drugs. Its the redundancy thats the most important, and if we have redundancy, we can shift to other manufacturing sources. The fda yesterday said that you mentioned this, the 20 drug products were either solely sourced for their active ingredients or finished drug products from china. Can you share that list with us, or is that proprietary . That is a proprietary list. We are compiling lists with all the questions weve been asking manufacturers. , how manyfield coronavirus tests does the us conduct as of today . How many tests has our country conduct as of today . Dr. Redfield i would have to get back to you with the exact number. I was serious to secretary azar. We have some deep cuts to these agencies, the people that youre sitting with and it was mentioned by i think the Ranking Member that the budget was printed and it couldnt be changed because of the print and all of that. I think the 200 million in cuts, 700 million in cuts in cdc, and 3 billion out of nih. Are you really are you willing to reconsider that given what our country is facing and what the American People need day in and day out from these agencies . They are the essentials. Sec. Azar the proposal to the budget do not impact our ability to do novel Coronavirus Response. The cdc has 135 million increase in the fields of Infectious Diseases. Rep. Eshoo in other words they deserve these cuts, these are healthy cuts. Its good for them and its good for our country. Sec. Azar you asked about impact related to Novel Coronavirus. We have the emergency supplemental request on top of that. Rep. Eshoo if you wrote it in december, how do you know that . Sec. Azar because the changes we make in the budget are not related to categories that will impact our ability to do the novel Coronavirus Response. Rep. Eshoo so theres nothing to reconsider. Sec. Azar i dont believe there is in terms of the existing Budget Proposal. Rep. Eshoo you know what . Today is february 26, 2020 and i certainly hope you are right, but i think that we are shortchanging the American People. It is time to recognize dr. Burgess, the Ranking Member of the subcommittee. I would point out we are the United States house of representatives and spending bills originate in the house of representatives, so it is well within our power to provide the level of spending your request. Yo requestu. I will be testifying to the Budget Committee tomorrow. If people have concerns, they ought to bring them to the Budget Committee. I hope we vote on a house budget because we havent in previous years. I want to thank the panel for being here today. The chair is correct this needs to be public. That is why we have hearingsm because they are public hearings, because they are public. Secretary azar, you were testifying on the budget before. You took questions on the office of Refugee Resettlement. I have been fortunate enough to visit a number of your facilities provided by the office of Refugee Resettlement. I think we are fortunate to have the men and women working in those facilities. Would you convey to them my thanks . I think we would be much the worse without the. Without them. The supply chain and the active pharmaceutical ingredients that we import from overseas and the fact was that there was an adequate stockpile as sort of the story began to evolve several weeks ago. What are, or to the extent you can tell us, how are things looking now as far as the stockpile that companies have available as far as the active pharmaceutical ingredient . Thank you, representative. As we discussed before, we received no reports of shortages and found no shortages and Prescription Drugs coming from china and we have discussed this with manufacturers and Pharma Companies and adequate supplies. Can i offer this observation, ive been on this subcommittee for a long time. Weve had this discussion in other guises and other times and if theres any Silver Lining to this cloud, it may be we recognize we need to bring some of that manufacturing back within our own shores so we are responsible we have the responsibility for the active pharmaceutical ingredients. I know this is something the president is focused on and part of his rebuilding of america, this is i think work that this subcommittee has done in the past. I think its something we need to take seriously. We had hearings on Continuous Manufacturing a few weeks ago, and i think that is another aspect of this where perhaps some attention to the Continuous Manufacturing, but the main e so we areke is her not dependent on a solesource from another country whether it be in difficulty from an infection or just simply out of sorts of the United States at the time. It does jeopardize our people and i do think we need to recognize that. Thats not a criticism of this panel. We have known about that on this subcommittee for a long time and we havent acted. Now perhaps we will. Dr. Redfield, i like to ask you the World Health Organization was able to finally get into china and assist them. Now that report is going to be coming back. Are you satisfied with the level of interaction you had with your chinese counterparts, because the cdc was not allowed to go in, it was only part of the World Health Organization . Dr. Redfield we were able to have a representative on the team that went to china to do the investigation. Ive had regular conversations my counterpart, the head of the cdc in china, and we had Good Exchange of scientific information. We have a cdc office in beijing, they that is there and continue to have good interactions with those colleagues. So you think there is working with state and local folks dr. Redfield there is good scientific interaction between us. Thank you for the work you are doing on getting a Laboratory Developed test. That is critical. They cant all be done at the cdc. We are going to have to get those tests done rapidly in the field for our people on the front lines, but is there any evidence that theres any sort of bargaining behavior with things like personal Protection Equipment or pharmaceuticals . Is that something about which we need to become concerned . In terms of the supply . We have reached out to manufacturers and we are aware that spot shortages can and have occurred. However, currently, we know of no overall shortage related to pp, but this is a dynamic situation as we mentioned at yesterdays press conference that we are likely to see some pressure, particularly on the demand side here, but we are working closely with manufacturers on this. Is there anything you can do to prevent hoarding activity by people who might just be buying up equipment . The department has led an old all department effort to communicate to providers and hospitals regarding this issue and have recommended following cdc guidelines with respect to the use of respirators. The gentlemens time is expired. Its my pleasure to recognize the gentlewoman from colorado for five minutes of questioning. Thank the chair for including other subcommittees. As four of the five of you well know, weve been having hearings in the oversight subcommittee for years on these issues. Its what keeps me up at night. The most recent hearing we had was on december 4 about seasonal flu and pandemic flu. And lo, here we are. What im concerned about is we are still not any more prepared than we were on december 4, and so thats what i want to talk about. Back in 2005, we had a National Blueprint or 2015. Some of you recognize this document. Colleague had now your job, mr. Secretary, and in this blueprint for defense, what they did was they said we need to have come in case we have some kind of a pandemic, we need to have a clear line of authority make these decisions. Are you aware of that . The blueprint . Sec. Azar i wasnt aware of the blueprint. I just got back from japan on monday, so we were really looking at the diamond princess incident. And heres what i was concerned about is you had all these People Living in this petri dish of a ship for a long time. The cdc said that people should not be flown back to the u. S. From that ship, and then apparently the cdc was overruled by the state department, so heres my question. You are the chairman of the president s task force on the Novel Coronavirus. Who is in charge . Are you in charge . Sec. Azar i am in charge, but in japan the chief of mission, he made the decision has full authority of the president of the United States in any foreign country. Thats the problem. It is. Ill tell you why thats the problem. Because you are the head of the panel. The Health Experts are saying you shouldnt be flying these people back in, and then theres another agency that basically overruled what you said. If we have an outbreak in the United States, there are a number of other agencies that are going to have other interests, and ill give you a couple of examples. State department, which we just dealtwith dealth w with. Hhs is you. The Public Health department, various other agencies. Who is in charge of the final verdict . Is it you . Sec. Azar it depends on the circumstances. That is not going to work in a pandemic. Sec. Azar the ambassador of the president is the final word. What happened is they flew back in 14 americans, maybe more who were infected with the coronavirus. Thats why someone needs to be in charge. You know what, i think it should be you. Respect, the dv eputy chief head of mission had a very difficult decision to make. I dont need you to explain that to me. What im saying is this goes along, there needs to be someone who can overrule Homeland Security and state, who can make these decisions for the American Public based on Public Health. Im hoping we can have some more hearings to talk about that. Dr. Redfield, i want to ask you. Asked you ashoo question about lab tests and you said you didnt know how many lab tests are available. Do we have lab tests that will accurately test for the coronavirus . Dr. Redfield yes. What i heard was they are limited and people have to send their test to the cdc to be tested, is that right . Dr. Redfield presently theres jurisdictions 12 jurisdictions that have the test up and running. 12 jurisdictions through the United States. When will we be able to put that everywhere . Dr. Redfield we are working cooperatively with i am asking, when are we going to put that everywhere . We are working with the fda now and hoping that later this week tests will be such that the first one can go, all the laboratories can execute the current test on the modification that we did with the fda. Dr. Fauci, i know you are working on developing a vaccine. If we gave you more money, could we develop a vaccine for more quickly . We would need more money to take it to the next step. We are in phase one right now and we are ok. How much more money . I think you can probably guess we would give you the money. How much money to get over the hill . About 140 million. If you wouldnt mind, the emergency supplemental would dedicate dedicate 1 billion for vaccine, just as part of the detail we will be working with the committee. One more thing, because my time is up and i know that the congresswoman is going to ask you questions about supplemental. I want to say that even minority leader mccarthy today said we need at least 4 billion, and we shouldnt be shifting money away from ebola and other diseases into trying to deal with this coronavirus. We need to work on all fronts at once and i thank you for your comments and i yield that. The gentlewomans time has expired. The gentleman from kentucky is recognized for his time. Just so everybody knows, we have been having these meetings, bipartisan with several of you over time. I remember when we first started are going to prepare for a pandemic. Thats what the American People expect us to do, put things in place for a pandemic and hope and hope it never comes. As we prepare for it, people are going to see things, hear things and react at this is imminent when it may not be because were doing what were supposed to do. The other thing is i know the Administration Needs to reassure markets and marketplaces where we are and where we stand. For everything that ive heard previously, what larry kudlow said is not inconsistent with where we are. Secretary azar, if youd like to explain, i know the cdc warned quote prepareld communities in the United States and should be ready for significant disruption. What do you want the American Public to know about the current state of american dealing with the coronavirus. Sec. Azar our messaging through a career officials at the cdc has been consistent, but striking a balance. Americas risk is low at the moment. That could change quickly. We are working to keep that risk low, but we have always been transparent that we expect more cases in the United States with rapidly spreading virus, especially with what we have seen. For the average american, there is no change in their behavior except what we already advise, which is practice good public hygiene, watching your hands, not touching your face with unwashed hands and appropriate preparedness activities at home. You can go to cdc. Gov for good preparedness and good thoughtfulness at home. We are trying to be transparent people about the risks we face, even if we are at a low risk situations of people are not surprised and they know what uncertainties we are dealing with. For 50 days weve learned much about the coronavirus, but much is still unknown. I know people want to know at home what is the current current Scientific Consensus about the transmissability of the virus . What are the remaining other known unknowns . What other things that you know that you would like to know the answer to . First of all, we know its a very transmissible virus. There are some viruses that are not efficient going from human to human. What weve learned early on and are convinced now, given what we have seen in china and other countries, it is a highly transmissible virus. Thats the first thing. The second thing, when you say how long a person is infected after they get infected, that is something thats up in the air and the way you get the answer to that is to try and isolate virus with what we call shedding for a period of time. There are individuals who are able to transmit without symptoms before they get symptoms. What we dont know yet, and i think were going to get information from the group, including the cdc individual and one of my people was in china with the w. H. O. Group, what the extent of that transmissibility is from an asymptomatic person. Is it minor . Part of the driving of the outbreak or is it significant . Thats going to be an important thing that is currently an unknown. I concur with dr. Fauci. The biggest challenge we have right now is the relative infectivity, whether before you get sick or you are infectious before you get sick, are you more infectious after you get sick . We are tracking these patients you have in this country to see how long they actually have a virus that can be isolated. From their respiratory secretions. Its probably going to be longer than many of us originally anticipated. Havenk at this stage, we an individual about 18 days from the time they initially got sick. I think these are key questions and we continue to try to get the data to answer them. So are there other things you are looking to know that you dont know that youre trying to find answers to . One of the other areas from the cdcs point of view is understand methods of transmission. Is it all respiratory transmission . For example, can this virus survived on certain survive o n certain surfaces long enough for somebody else to come down, put their hand on and touch their face . Its not clear right now what the relative components of say droplet transmission is due for transmission. My time is expired and i will yield. The gentleman yields back. The gentleman from illinois is recognized. As all of you know, the World Health Organization has declared the coronavirus outbreak a Global Health emergency and our administration now has declared it a Public Health emergency. Secretary azar, we talked about this. The Trump Administration asked 2. 5 billionr just to combat the disease at the director who warned could severely disrupt daily life and cause severeould illness in the United States. Tn that request, you did no include or were not specific about surveillance or testing kits that actually work, because not all of them have, and for treatment. Instead, you suggested robbing 500 million from the United States response to ebola academic, which actually still is raging in places. So i find it incomprehensible that you are asking for a molehill when what we really need is a mountain of support here. Secretary azar, yes or no, you agree the president of the United States that the coronavirus is very much under control in the United States and spring . Away by sec. Azar he did not say the last part that you just said. He said we hope it will go away with warmer weather. I hope everybody would hope it would go away with warmer weather. The virus in the United States has been in a contained situation to date, but that can change. We expect more cases and we expect we will see at least a little Community Transmission of the virus in the United States. Let me just ask another question. My hometown of chicago reported the first human to human transmission of the coronavirus in the United States and though the illinois and cook county and chicago departments of Public Health have expertly handled our two coronavirus cases, they have not received any reimbursements or Financial Assistance for what theyve done. I just met with the director of Public Health in chicago. Who said they are spending 150 ,000 per week to respond to this. Will the United States be able able to2. 5 billion be help local and state Health Officials who have already spent lots and lots of money trying to deal with this . Sec. Azar yes, that is part of the supplemental request to fund state and locals in addition to the 675 million money they already have received for many years. Illinois of course received each year 16. 3 million for exactly these activities, but we want to give additional funding through the supplemental request for those activities. Thats good news, thank you. Secretary azar, will your 2. 5 billion be enough to help healthcare workers in hospitals and Nursing Homes or home care workers who have to care for quarantined individuals . Sec. Azar in what respect . Salaries . They are already paid. If there are elements we need to add to our request there may be additional cost that people that work in hospitals and they may have to hire more people. Is there going to be help for staffing . 350 million is dedicated for personal protective equipment that can be used by healthcare workers in many different settings. So we are stockpiling that to make it available should communities need that in addition to what they have on hand. Let me finally say this, last week, 45 of my colleagues and i sent sent a letter to President Trump and what we were talking about is are we going to have the guaranteed affordable treatments or vaccines that are developed . We are concerned that private pharmaceutical Companies May end up having a role in this and raising the cost beyond the point that people could well afford. Sec. Azar we absolutely share your passion around ensuring Affordable Access to medicine. But the private sector must have a role in this. We will not have therapeutics without the private sector candidates that they and we will have to invest in. We have paid for all of the r d so far. Product funded out of the university of alabama. My time has expired. You are saying for sure it will be affordable for anyone who needs it. Sec. Azar im saying we would want to ensure we work to make it affordable, but we cant control that price because we need to private sector to invest. The gentlewomans time is expired. Sec. Azar price controls wont get us there. I now recognize the gentleman from michigan. Ive had a couple questions that i hope to run through and i is the first question ought to be first, thank you all. Be directed to dr. Redfield. Theres a report just published apparently theres a daily newspaper in korea and they reported there is a Korean Airlines Flight Attendant who serviced a number of flights between lax and seoul. She was confirmed to have coronavirus. Was some suspicion she had worked on a flight to israel, with that apparent Tourist Group that came from korea there in the previous week. What do you know about this . I hope you know something. It was published tuesday in korea. It is thursday now, so just wondering what you might know about this. Dr. Redfield i can say i havent been briefed on that. This is a korean woman, 24 years old. Dr. Redfield we are interacting. Yesterday tone embed in the korean cdc to help facilitate communications between koreas cdc and our cdc. I can look into the specific situation and get back to you. China didci, i know sequence,e genomic which allowed the rest of the world to try and pierce the ball here. Moderna therapeutics is one of the countries the companies out of massachusetts working on phase one, but i may be wrong. Long . Is successful, how we are working with the company on a platform called messenger rna. Were working on our Vaccine Research center and we did exactly as you said, as soon as the sequence was put on a public database, we pulled the gene out for the spiked protein, which is a protein you want to make an immune response against. There were several steps that determine the success or failure of what youre doing, and weve been able to successfully express it in this particular platform that were going to use for a vaccine. We have shown that its immunogenic in mice, and very soon within the next month and a is to go into a phase one study. A phase one study will be three months from the go, which was about a month and a half ago, will take about three months or four to determine if its safe and induces the kind of response you would predict would be protective. Relates get there, it to the question that i was asked before, then you go to a phase two study. A phase one study has 45 people. Orse two has thousands hundreds of people. So from the time you push the button to go from the time you even know what works, about a year to year and a half. Then, as the secretary said, you have to partner with pharmaceutical companies to make millions and millions of doses, which could also extend the time. That would be a vaccine or a remedy . A vaccine to prevent infection. Last question i have and ill save this for secretary azar, a couple weeks ago my colleague Debbie Dingell and i sent a letter to the administration. You were copied on it. As it relates to the supply chain of companies with operations in china, specifically wuhan province. A lot of us are concerned about products that are made there. I know apple as an example, their stock price collapsed and led to the market trouble that we had here this week. What type of outreach have directed e you have you initiated outreach to companies, large and small, particularly on the shortage question . Because they may not want to tell you what they might not know. Sec. Azar as chair of the task force, we directed the whole government outreach to manufacturers and suppliers across not just healthcare, but everywhere. Dr. Kadlec and dr. Hahn have led the effort with regard to generic and biologic and Device Manufacturers in china and thats what doctor hahn was reporting on earlier, the result of that outreach. Im proactive as you know with drugs. They have to report potential shortages. We are proactively probing that system. We dont yet know of any potential shortages, but we are on that because we share your concern about the risk there. Just to follow up, secretary of commerce, are they working other than beyond drugs and devices . Sec. Azar yes. With their related entities their major manufacturing entities they are working to gather information about potential shortages as they might impact the economy. The National Security council, National Economic council are leading those efforts. I appreciate what was raised overall, the whole issue of our dependence on china. 90 of the American People take generics and those generic drugs are manufactured in china, and to a lesser degree, in india. But china controls the Global Market on the api, the active pharmaceutical ingredients. Met with dr. Kadlec i think it was a classified briefing. Whowe have an inventory of manufacturers are . Are any of these plants shut do wn . I know there are questions about how long they can manufacture until they cant. Because drug shortages are a part of this whole problem with the supply chain. When i met with dr. Kadlec, we dont have that inventory. Is that in place now . Sec. Azar i believe that is what dr. Hahn review on earlier. Briefed you on earlier. Dr. Hahn we reached out to the manufacturers, we do that proactively because there are not requirements to report to us. Rep. Eshoo but they inspect manufacturing plants, dont know who they are . We do. Whats the difference between that and the question i asked . Dr. Hahn we have a list of manufacturers given to us by pharmaceutical companies who manufacture both precursor products and final drugs in china. But there may be five or six for each of these drugs, and they might be around in different countries. Rep. Eshoo i see. 03 52 45 the gentleman from massachusetts Mister Kennedy is recognized for his five minutes. Thank you for being here, thank you for being willing to be before this committee. I have some differences with some of you on our healthcare policy, not im grateful for and i wish you all success, so good luck to you and good luck to us all. Dr. Redfield, i have a twoyearold and fouryearold and a lot of other parents of Young Children are nervous about this. Can you give me an answer to parents of young kids, if there are any thing people should be doing or we should be concerned about . Dr. Redfield the risk to the American Public is low. We would argue that they go on with their life. Our containment strategy has been quite successful, but that said, what was said also is in light of what happened in korea and italy and iran and japan and we have seen how fast this virus can move, we are encouraging people to just think about being prepared. Part of being prepared is trying to make sure theres as much Clear Communication as to what we are confronting and how government is structured to be ready. Some of my colleagues have noted despite calls to strengthen our pandemic preparedness, this administration did dismantle a Pandemic Response chain of command including Leadership Structure at the white house through the National Security council Global Health security unit. So Flash Forward to this year and the coronavirus is spreading, there are reports of this task force and you can you communicate what that structure looks like so that people can have understanding as to what is backing that up . Just to get that information out would be helpful to all of us. Moving on to try to make sure there is not just structure in place, but that communication is in fact clear. It would take a bit of an issue with the fact that the message is consistent. The message from you all so far has been pretty consistent. I have an abc news story that quotes the president directly that says it is a problem that is going to go away. The president is also quoted by saying the virus we are talking about, you know, a lot of people think it goes away in april with the heat as the heat comes in. Typically that will go away in april. We are in great shape. Does this go away in april with the heat . The history of respiratory viruses and other coronaviruses tend to diminish and almost disappear as you get into the summer. That is just something that happens every year. Happens. Every year we see that with influenza. However, this is a new virus. We dont know what this virus is going to do. If it acts like influenza, the heat will make it diminished. We dont know how it is going to act. I would say there are different temperature gradients across this country in april, fair enough . Yes, and also in different hemispheres when we are having cold weather, others are having warm and vice versa. You also stated we are very close to a vaccine, but doctor you just laid out that best Case Scenario we are still 18 months away . Is that correct . Congressional staff briefed folks yesterday on a press conference that its not a question of if but rather when and how many people this country will have severe illnesses. Almost at the exact same time the president was saying that is going to work out fine and a problem thats going to go away. Dr. Redfield, does the cdc a great that this is a problem that is going to go away without intervention . Dr. Redfield it is important to recognize new pathogens come from animals that get to the human species. This is one of those times we had a new respiratory pathogen. I think it is prudent to assume this pathogen will be with us for some time to come. We dont know the cycle of it. We dont know if it will be impacted by humidity and heat. Virussafe to assume this is one we will be challenged with. Yes or no, agree with dr. Redfield . I support dr. Redfields vi ew. Sec. Azar the president is expressing confidence in this country that we can deal with this. We will Work Together on this. Public. Ying to calm the we have seen in china panic can be i dont want to panic over this either. He is outright contradicting everything you have said. Sec. Azar i think he is expressing confidence no medical basis for it. Sec. Azar he is expressing the American People need to take a breath, that there is no change to anyones daily life. We have pandemic plans. We have to be realistic and transparent that we will have more cases. As head of hhs, do you agree with the president s statement that it will go away with the heat . Rep. Eshoo the gentlemans time has expired. You are doing a great job for the president , mr. Secretary. We recognize the gentlewoman from indiana. Thank you for your work on behalf of not only our country, but the world. I would like to remind my colleagues that in november of 2019, the u. S. Was ranked number one in Global Health security. The Global Health Security Index conducted by john hopkins of 195 countries, we are leading the world. That does not mean we cant continue to improve. It focused on vulnerable populations like children and the elderly. One thing i am concerned ofut is the flexibility funding. 705 million in a strategic stockpiles on. Do we need to give you more authority . Flexibility to be able to not focus on congress happened to do supplementals. How much more flexibility do you need . Sec. Azar the flexibility the strategic National Stockpile critical. The emergency supplemental is most flexible as we deal with the situation. The challenge with seven of longterm funding mechanisms that are two different is it can become are indefinite is it can become slush funds. If you find you need more funding, will you come back and ask for more . Sec. Azar the 2. 5 is for 2020 forwe will go to congress more. Regard to the stockpiles you oversee in conjunction with the cdc, what is the status of our strategic National Stockpiles . It is a variety of countermeasures that deal with chemical, Radio Nuclear capabilities. We have a supply of personal protective equipment on hand. We sent a solicitation to get more. These are at undisclosed locations throughout the country. Stockpileint, is the sufficiently funded . At this point, in light of the requirements we have been given, we have been given another 400 million. That would be a great benefit to address shortfalls. Last week i learned from a local Public Health official in indiana an individual from this county traveled from china and interestingly came through the chicago airport. The chicago airport officials notified this Public Health official, said this person is coming home to quarantine. She appeared at this individuals home within 24 hours of coming within the chicago airport. I thought that was excellent that coordination happened. How did that happen . Is it happening across the country . This individual will work with local Health Officials. Is this happening across the country . Yes. Who at the airport is notifying local Health Officials . When travel restrictions were put in for china and hubei, if you were coming to the United States from hubei, you are required to go into 14 days of quarantine. That could have been institutional or in your home working with the Health Department. If you had been from china, the requirement was when you came through you were screened, you were given an education card telling you about the symptoms and the Contact Information with your local Health Department. You in conjunction with your local Health Department were coming into voluntary monitoring and isolation. That woman you gave the example of did exactly as was instructed. My local Public Health official who was impressed she received this information. Id like to enter into the record, cfis produced a report in 2019 about global u. S. Health security with a number of recommendations. I ask that be entered into the record. I yield back. Rep. Eshoo the gentleman from california is recognized for four minutes. For those left, there is an minutest it is four because the panel is getting noticed about time. I wanted to discuss an important issue for local agencies. Many other members are hearing as well that funding and ourbursement for money Health Officials have spent upfront to find the Coronavirus Fight the coronavirus. Method reimbursement is rapid reimbursement is a matter of readiness capacity. We can agree a lot is being asked from the Public Health infrastructure in our states. They are coordinating. On january 29, flight carrying 195 americans from wuhan china is in riverside county, my district. Riverside county was efficient at monitoring and quarantining these passengers. Over 40 county officials worked on this project. The county supplied food, supplies, a mobile Health Clinic and support services. All told, these efforts are estimated at 1. 3 million. While the quarantine is over, the stronger response continues in riverside and communities across the country. Receiving rapid reimbursement is critical to Capacity Readiness in the future. If you drain resources without replenishing them, you will not be able to fight this health crisis. Masks, to name a few, and having the resources to create plans in a case of Rapid Transmission of the virus in the future. Dr. Redfield, what are the Funds Available to reinforce state and local officials for their effort responding to coronavirus . Dr. Redfield i think the secretary said in the supplemental the last time we spoke, you identified someone in your staff. Now you are saying those funds dont exist. We need to pass the supplemental to reimburse counties. Dr. Redfield the step funds california at 41 million a year the state and local funding. Can counties right now apply . There is no additional to the emergency funds they get for these activities. We agree. We are going to work on that. We were under the impression there were. Rapid reimbursement is a matter of readiness capacity. Agencies willocal not be able to deal with a rapid spread of the virus. Dr. Kadlec, dr. Redfield, yes or no, can we get a commitment from you you will reimburse these expenses for municipalities dealing with the spread of the coronavirus . We will clearly work to see how to get that done. That is not a commitment. Dr. Kadlec we will work with you to do that. We need to reimburse. Especially in rural areas where they dont have the resources, the quarantined spaces, you are putting them in vulnerable situation if you dont respond. Dr. Redfield, since 2008, local and state health apartments have lost nearly a quarter of their workforce. I think it is one of the key capabilities we need to need to improve our public ability. The Laboratory Capacity to build and keep the fluid, as you see with the public diagnostic test, and the third most important one is the workforce. The key is be consistent. No discrepancy. Discrepancy breeds anxiety. That brings panic. All right. I wanted to get a commitment so that these agencies dont lose the money that they are you that they are losing. You are asking them to promise you even beyond where the cuts are. I would be happy if it could happen, but the congress has a job to do to restore the money in these agencies. These cuts are really shameful. They really are. Such premier agencies, people at the top that know what they are doing and they are being cut. The secretary says we did one point 5 billion, everything is going to be fine. I dont think so. Thanks for the five minutes. I appreciate it. No, four minutes. Just kidding. In reference to the funding, the congress provides funding for the agencies, and a Budget Proposal is a Budget Proposal, no matter which president it comes from, so im not too worried this congress will not provide the appropriate level of funding, and i also understand that additional funding, if he could quickly bring up the asset that inand my opinion clearly would help. Comment briefly on the criticism of the president and what he has said. Of the unitednt states comes out and insights a panic in the United States and insights a worldwide panic, and ee the role of president even though the president says what he says, i do think having a calming effect in a situation like this is appropriate and allow the professionals behind the scenes to do their jobs. I just wanted to say that. Agree entirely. I think the president s role has been critical in keeping the country come in this situation. He has expressed the levels of doubt and uncertainty with his words that we have but also tried to reassure the American Public as we also try to be transparent about what the risks are coming forward. We all have different roles to play here, as you said, and the president s is a very important one guiding towards balance, maturity, and calm. I would agree. If the president came out and incited a panic, he would be criticized for that. Know, we had this unprecedented containment strategy in china. Now that we know we have problems with persontoperson transmission in italy and south korea and maybe other places, does that changed our current containment strategy . I would say first that we are maintaining aggressive containment. Of all the strategies we have used in this multilayered strategy, the most important one we have is an astute medical and Public Health community in the United States. Those 14 cases originally that were diagnosed, all but 1 only one was picked up on screening, so we are now moving, obviously, to educate the american medical and Public Health community. It is not just china we have to worry about now. We have to worry about certain places in italy, karen, italy, korea, certain places in japan. Turn to let the public know this may not be the time to go to those areas. Great. Secretary as are, you have anything to add to that . Asin, dr. Redfield, as far testing goes, the cdc, 12 other have had problems with the tests. Can you ask lane the problems with the tests, and have they been resolved . First, the test measured three different nucleic acid pieces, and one of them had a control the third one had a control, and in that control, there was lowlevel contamination. There was never any question about if the test would tell positive or negative. It was just a group of individuals that we had to say we did not know. Those samples, again, were at the cdc. The cdc has continued. There were 350 to 500 samples a day. Where the problems resolved . The problem has been resolved. We work with the fda. Have you guys conducted disease modeling for potential covid19 outbreak in the u. S. . We do have Modeling Groups. Its a Modeling Group looking at a variety of different models, and that is in process. As tony said, earlier, theres a number of things we dont quite know about this model, but we are working on it. Thank you very much. I yelled back. The gentleman yields back. I think that concludes the you today. E have for mr. Secretary, you have been here for many hours, and you know, throw a punch, take a punch, right . For our fellow americans, and i think if there is anything that has come out of this today, we want facts. We want to bring the temperature down. We want to bring the fear factor down, and anything and everything you can do in order onachieve that as we move with larger distribution of the diagnostics in partnership with what we have across our country is going to go a long way, so thank you to each one of you. Im not going to adjourn. You can get up and leave while i read a very long record of items into the to be placed record. Thank you. God bless you and your work on behalf of the American People. Thank you. All right, im going to request a i have a unanimous consent request to enter the following documents into the record. In june 28 letter from four house committees to hhs and cms regarding the case texas versus the United States. A december letter from four house committees to hhs and cms regarding the case texas versus the United States. Lee february 2020 letter from hhs in response to the april 2019 joint letter from five house committees regarding the case texas versus the United States. The committee actually is still in order. If anyone wants to gab, take it to the side room so that i can read this into the record please. Letter from hhs regarding the case texas versus the United States. In october 20 19th Washington Post article entitled from Campaign Urges white house to faith ban. Osed a bicameral letter to hhs from two congressional committees regarding the increased number of uninsured children in the United States. June 2019 letter from the energy and Commerce Committee examining hhs administration of the Medicaid Program. The statement from johnson regarding the companys response to the coronavirus outbreak, the statement from the American Society war microbiology regarding the coronavirus outbreak, february 2020 article entitled bio farm academic pushback against demands for price control. It wall street journal opinion piece entitled farmer to the rescue. Are there any objections . Without objection, so ordered, the Committee Subcommittee will now adjourn. Thank you, everyone. Unfiltered view of government. Created by cable in 1979 and brought to you today by your television provider. Look at our live coverage thursday. On cspan, the house meets at 10 00 a. M. Eastern for general speeches, legislative business at noon. On the agenda, a bill that would ban the sale of all flavored Tobacco Products including ecigarettes. Atcspan2 the senate is back 9 30 to consider a judicial nomination for the u. S. Tax court. , betsy devos 10 00 is on capitol hill, testifying on the president s 2020 one budget request for her department. Then in the afternoon, the cdc director appears before the House Foreign Affairs subcommittee with state Department Officials talking about the u. S. And interNational Response to the coronavirus outbreak. That gets underway at 2 00 eastern. Coming up on washington journal, democratic congresswoman Jan Schakowsky talks about the u. S. And Global Response to the coronavirus outbreak. Then we hear from republican congressman Warren Davidson on the topic and his proposal to reform government surveillance programs
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